Beyond apical ballooning: computational modelling reveals morphological features of Takotsubo cardiomyopathy

Abstract

Takotsubo cardiomyopathy (TCM) is characterized by transient myocardial dysfunction, typically at the left ventricular (LV) apex. Its pathophysiology and recovery mechanisms remain unknown. We investigated LV morphology and deformation in n ¼ 28 TCM patients. Patients with MRI within 5 days from admission ("early TCM") showed reduced LVEF and higher ventricular volumes, but no differences in ECG, global strains or myocardial oedema. Statistical shape modelling described LV size (Mode 1), apical sphericity (Mode 2) and height (Mode 3). Significant differences in Mode 1 suggest that "early TCM" LV remodeling is mainly influenced by a change in ventricular size rather than apical sphericity.

Analysing functional implications of differences in left ventricular morphology using statistical shape modelling

“…This study focused on CMR LV shape characterization for the first time in four different groups, i.e., isolated CoA, CoA + BAV, isolated BAV and healthy controls. A computational analysis was performed to compute LV average and shape deformations within the population using a methodological framework previously described by our team and colleagues 7 , 18 . Qualitative assessment of the group templates showed that patients with isolated CoA had a shorter and more spherical configuration on average, also quantitatively confirmed by a higher sphericity index.…”

“…Limitations This study has the disadvantages of being a retrospective design with a relatively small number of patients per subgroup. Nevertheless, the overall population (n = 110) is one of the largest described using SSM, with previous studies modelling smaller populations 7,27,33 . Blood pressure data (cuff pressure at the time of CMR) were not available, thus a history of hypertension, as found in clinical notes, was reported instead.…”

“…Three-dimensional (3D) patient-specific anatomical information can be derived by non-invasive imaging techniques, such as cardiovascular magnetic resonance (CMR) imaging. This allows further exploration of LV morphology using tools such as statistical shape modelling (SSM), which our group has previously applied to capture apical ballooning in Takotsubo cardiomyopathy 7 and other studies used to assess aortic and LV remodelling in scenarios such as myocardial infarction, AAo thoracic aneurysm and aortic stenosis [8][9][10][11] . Here, we apply this methodology to congenital heart disease (CHD), particularly to aortic coarctation (CoA) and bicuspid aortic valve (BAV) disease, which have a prevalence of 3/10,000 and 1-2% respectively 12 .…”

Myocardial Fluid Balance and Pathophysiology of Myocardial Edema in Coronary Artery Bypass Grafting

“…Statistical shape modeling was generated into three modes and was introduced as left ventricle size model, apical sphericity model, and height model. e models suggest that significant differences can be observed in mode 1, left ventricle size model, which suggests that early Tako Tsubo cardiomyopathy left ventricle remodeling is mainly influenced by a change in ventricular size rather than apical sphericity [64]. A study by Lopez-Perez et al [65] demonstrates a three-dimension cardiac computational model.…”

“…e study implies that a similar technique can be adapted to reconstruct how cardiac muscle cells formed in CABG setting. Another study by Pontecorboli et al [64] reveals a morphological feature of Tako Tsubo cardiomyopathy using a computational model. e theory said that transient myocardial dysfunction could be identified at the left ventricular apex.…”