Temporal changes within mechanical dyssynchrony and rotational mechanics in Takotsubo syndrome: A cardiovascular magnetic resonance imaging study

Abstract

BackgroundThe pathophysiological significance of dyssynchrony and rotation in Takotsubo syndrome (TTS) is unknown. We aimed to define the influence of cardiovascular magnetic resonance feature tracking (CMR-FT) dyssynchrony and rotational mechanics in acute and during clinical course of TTS.MethodsThis multicenter study included 152 TTS patients undergoing CMR (mean 3 days after symptom onset). Apical, midventricular and basal short axis views were analysed in a core-laboratory. Systolic torsion, diastolic recoil and dyssynchrony expressed as circumferential and radial uniformity ratio estimates (CURE and RURE: 0 to 1; 1 = perfect synchrony) were compared to a matched control group (n = 21). Follow-up CMR (n = 20 patients; mean 62 days, SD 7.2) and general follow-up (n = 136; mean 3.3 years, SD 2.4) were performed.ResultsCURE was initially reduced compared to controls (p = 0.001) and recovered at follow-up (p < 0.001) as opposed to RURE (p = 0.116 and p = 0.179). CURE and RURE discriminated between ballooning patterns (p = 0.001 and p = 0.045). Recoil was generally impaired during the acute phase (p = 0.015), torsion only in highly dyssynchronous patients (p = 0.024). Diabetes (p = 0.007), physical triggers (p = 0.013) and malignancies (p = 0.001) predicted mortality. The latter showed a distinct association with impaired torsion (p = 0.042) and dyssynchrony (p = 0.047). Physical triggers and malignancies were related to biventricular impairment (p = 0.004 and p = 0.026), showing higher dyssynchrony (p < 0.01), greater reduction of left ventricular function (p < 0.001) and a strong trend towards increased mortality (p = 0.074).ConclusionTransient circumferential dyssynchrony and impaired rotational mechanics are distinct features of TTS with different severities according to the pattern of ballooning. Patients with malignancies and precipitating physical triggers frequently show biventricular affection, greater dyssynchrony and high mortality risk.

Current Knowledge and Future Challenges in Takotsubo Syndrome: Part 1—Pathophysiology and Diagnosis

“…CMR-feature tracking (FT) is considered to be an emerging tool for the quantitative analysis of regional LV deformation corresponding to speckle tracking echocardiography, thus affording the quantification of biatrial and biventricular measures of deformation, i.e., strain, dyssynchrony, and torsion [ 101 ]. Indeed, global longitudinal strain has been reported to be able to serve as a potential determinant of outcome in TTS [ 102 ]. Furthermore, impaired rotational mechanics and transient circumferential dyssynchrony have been identified as characteristic CMR-FT features in TTS [ 102 ].…”

“…Indeed, global longitudinal strain has been reported to be able to serve as a potential determinant of outcome in TTS [ 102 ]. Furthermore, impaired rotational mechanics and transient circumferential dyssynchrony have been identified as characteristic CMR-FT features in TTS [ 102 ]. RV myocardial strain analysis using CMR-FT allows for the exact evaluation of RV involvement in TTS ( Figure 2 ).…”

“…RV myocardial strain analysis using CMR-FT allows for the exact evaluation of RV involvement in TTS ( Figure 2 ). These novel parameters may help to identify high-risk patients, though this needs to be validated in prospective studies [ 102 ].…”

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

“…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.…”

A valuable cardiac magnetic resonance investigation after MINOCA/takotsubo Syndrome: a case report

“…Technological advances might help improve the specificity and sensitivity of CMR in MINOCA; for instance, with free-breathing high-resolution LGE CMR imaging 18 or feature-tracking CMR. 19 In the international expert consensus document on TTS, 9 follow-up investigations mainly focus on using transthoracic echocardiography to monitor left ventricular function. Follow-up CMR is only advised in cases with persistent regional wall motion abnormalities to exclude MI or myocarditis.…”