Left ventricular myocardial deformation in Takotsubo syndrome: a cardiovascular magnetic resonance myocardial feature tracking study

Stiermaier, Thomas; Lange, Torben; Chiribiri, Amedeo; Möller, Christian; Graf, Tobias; Villnow, Christina; Raaz, Uwe; Villa, Adriana; Kowallick, Johannes T.; Lotz, Joachim; Hasenfuß, Gerd; Thiele, Holger; Schuster, Andreas; Eitel, Ingo

doi:10.1007/s00330-018-5475-2

Cited by 28 publications

(28 citation statements)

References 31 publications

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“…Another recent trial showed that LVGLS was the only independent predictor of functional recovery in patients with myocarditis [18]. A high predictive value of LVGLS was also shown for other myocardial diseases like Takotsubo cardiomyopathy, ST-segment elevation myocardial infarction and chemotherapy induced cardiomyopathy [12,13,19]. Future investigations are warranted to evaluate the relationship between early changes in deformation parameters and clinical outcome in IIM patients.…”

Section: Discussionmentioning

confidence: 97%

“…It has also been shown to be a valuable tool for detection of cardiac involvement in patients with IIM [10,11]. With modern methods of feature tracking, measurement of myocardial deformation has shown its prognostic value in different cardiac entities [12,13]. Aim of our study was to evaluate myocardial deformation parameters in IIM and their development over time.…”

Section: Introductionmentioning

confidence: 99%

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Myocardial involvement and deformation abnormalities in idiopathic inflammatory myopathy assessed by CMR feature tracking

Kersten

Güleroglu

Rosenbohm

et al. 2020

Int J Cardiovasc Imaging

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Background Cardiac involvement has been described in idiopathic inflammatory myopathies (IIM), including non-specific ECG and echocardiographic findings. Aim of our study was to evaluate myocardial deformation parameters in IIM and to correlate them with late gadolinium enhancement (LGE) findings using cardiac magnetic resonance imaging (CMR). Methods Forty-seven consecutive patients with histologically proven IIM were included into our study. Twenty-five healthy volunteers were used as a control group. All patients and controls underwent CMR examination using a 1.5 T scanner including functional cine and LGE imaging. After a mean follow-up of 234.7 ± 79.5 days a second CMR examination was performed in IIM patients. Results In comparison to healthy volunteers, IIM patients had lower left ventricular mass and left ventricular global radial, circumferential and longitudinal strain. There was no significant difference in left ventricular ejection fraction. Patients with LGE (N = 28) had lower left ventricular ejection fraction (p = 0.016), global right and left ventricular longitudinal strain (p = 0.014 and p = 0.005) and global left ventricular diastolic longitudinal strain rate (p = 0.001) compared to patients without LGE (N = 19). In IIM patients, a significant decrease of left ventricular ejection fraction, left ventricular mass and all measured deformation parameters was observed between baseline and follow-up CMR. Conclusion Cardiac involvement in IIM is frequent. Impairment of systolic and diastolic deformation parameters and a worsening over time can be observed. CMR is a useful tool for cardiac diagnostic work-up of these patients.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Myocardial involvement and deformation abnormalities in idiopathic inflammatory myopathy assessed by CMR feature tracking

Kersten

Güleroglu

Rosenbohm

et al. 2020

Int J Cardiovasc Imaging

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“…Recently, CMR-feature tracking (FT) has been introduced as a new method to quantify regional LV deformation similarly to speckle tracking echocardiography, providing a more reliable and accurate assessment of (dys-)synchrony as well as rotational parameters [ 98 ]. In TTS patients, CMR-FT of the left and right ventricles has shown promising results [ 66 , 99 ]. Transient circumferential dyssynchrony and impaired rotational mechanics are distinct features of TTS with varying degree of severity according to the ballooning pattern.…”

Section: Cardiac Magnetic Resonancementioning

confidence: 99%

Multimodality imaging in takotsubo syndrome: a joint consensus document of the European Association of Cardiovascular Imaging (EACVI) and the Japanese Society of Echocardiography (JSE)

et al. 2020

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Takotsubo syndrome (TTS) is a complex and still poorly recognized heart disease with a wide spectrum of possible clinical presentations. Despite its reversibility, it is associated with serious adverse in-hospital events and high complication rates during follow-up. Multimodality imaging is helpful for establishing the diagnosis, guiding therapy, and stratifying prognosis of TTS patients in both the acute and post-acute phase. Echocardiography plays a key role, particularly in the acute care setting, allowing for the assessment of left ventricular (LV) systolic and diastolic function and the identification of the typical apical-midventricular ballooning pattern, as well as the circumferential pattern of wall motion abnormalities. It is also useful in the early detection of complications (i.e. LV outflow tract obstruction, mitral regurgitation, right ventricular involvement, LV thrombi, and pericardial effusion) and monitoring of systolic function recovery. Left ventriculography allows the evaluation of LV function and morphology, identifying the typical TTS patterns when echocardiography is not available or wall motion abnormalities cannot be properly assessed with ultrasound. Cardiac magnetic resonance provides a more comprehensive depiction of cardiac morphology and function and tissue characterization and offers additional value to other imaging modalities for differential diagnosis (myocardial infarction and myocarditis). Coronary computed tomography angiography has a substantial role in the diagnostic workup of patients with acute chest pain and a doubtful TTS diagnosis to rule out other medical conditions. It can be considered as a non-invasive appropriate alternative to coronary angiography in several clinical scenarios. Although the role of nuclear imaging in TTS has not yet been well established, the combination of perfusion and metabolic imaging may provide useful information on myocardial function in both the acute and post-acutephase.

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“…Cardiac magnetic resonance (CMR) imaging has emerged as a useful and widespread modality for the assessment of both myocardial morphology and functional performance with an incremental prognostic value [2][3][4][5][6]. CMR feature tracking (CMR-FT)-derived strain analyses have been shown to provide useful and superior functional analyses in a wide range of cardiovascular diseases [7][8][9][10]. Tracing left-ventricular (LV) epi-and endocardial borders of the myocardium allows a comprehensive deformation assessment on a global and regional level.…”

Section: Introductionmentioning

confidence: 99%

Functional and prognostic implications of cardiac magnetic resonance feature tracking-derived remote myocardial strain analyses in patients following acute myocardial infarction

et al. 2020

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Background Cardiac magnetic resonance myocardial feature tracking (CMR-FT)-derived global strain assessments provide incremental prognostic information in patients following acute myocardial infarction (AMI). Functional analyses of the remote myocardium (RM) are scarce and whether they provide an additional prognostic value in these patients is unknown. Methods 1034 patients following acute myocardial infarction were included. CMR imaging and strain analyses as well as infarct size quantification were performed after reperfusion by primary percutaneous coronary intervention. The occurrence of major adverse cardiac events (MACE) within 12 months after the index event was defined as primary clinical endpoint. Results Patients with MACE had significantly lower RM circumferential strain (CS) compared to those without MACE. A cutoff value for RM CS of − 25.8% best identified high-risk patients (p < 0.001 on log-rank testing) and impaired RM CS was a strong predictor of MACE (HR 1.05, 95% CI 1.07–1.14, p = 0.003). RM CS provided further risk stratification among patients considered at risk according to established CMR parameters for (1) patients with reduced left ventricular ejection fraction (LVEF) ≤ 35% (p = 0.038 on log-rank testing), (2) patients with reduced global circumferential strain (GCS) > − 18.3% (p = 0.015 on log-rank testing), and (3) patients with large microvascular obstruction ≥ 1.46% (p = 0.002 on log-rank testing). Conclusion CMR-FT-derived RM CS is a useful parameter to characterize the response of the remote myocardium and allows improved stratification following AMI beyond commonly used parameters, especially of high-risk patients. Trial registration ClinicalTrials.gov, NCT00712101 and NCT01612312 Graphic abstract Defining remote segments (R) in the presence of infarct areas (I) for the analysis of remote circumferential strain (CS). Remote CS was significantly lower in patients who suffered major adverse cardiac events (MACE) and a cutoff value for remote CS of − 25.8% best identified high-risk patients. In addition, impaired remote CS ≥ − 25.8 % (Remote −) and preserved remote CS < − 25.8 % (Remote +) enabled further risk stratification when added to established parameters like left ventricular ejection fraction (LVEF), global circumferential strain (GCS) or microvascular obstruction (MVO).

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Left ventricular myocardial deformation in Takotsubo syndrome: a cardiovascular magnetic resonance myocardial feature tracking study

Cited by 28 publications

References 31 publications

Myocardial involvement and deformation abnormalities in idiopathic inflammatory myopathy assessed by CMR feature tracking

Myocardial involvement and deformation abnormalities in idiopathic inflammatory myopathy assessed by CMR feature tracking

Multimodality imaging in takotsubo syndrome: a joint consensus document of the European Association of Cardiovascular Imaging (EACVI) and the Japanese Society of Echocardiography (JSE)

Functional and prognostic implications of cardiac magnetic resonance feature tracking-derived remote myocardial strain analyses in patients following acute myocardial infarction

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