Myocardial oedema contributes to interstitial expansion and associates with mechanical and electrocardiographic changes in takotsubo syndrome: a CMR T1 and T2 mapping study.
| Title: | Myocardial oedema contributes to interstitial expansion and associates with mechanical and electrocardiographic changes in takotsubo syndrome: a CMR T1 and T2 mapping study. |
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| Authors: | Arcari L; Cardiology Unit, Madre Giuseppina Vannini Hospital, Via di Acqua Bullicante 4, 00177 Rome, Italy.; Camastra G; Cardiology Unit, Madre Giuseppina Vannini Hospital, Via di Acqua Bullicante 4, 00177 Rome, Italy.; Ciolina F; Radiology Unit, Madre Giuseppina Vannini Hospital, Via di Acqua Bullicante 4, 00177 Rome, Italy.; Limite LR; Service de Cardiologie, Hopital Privée Les Franciscaines ELSAN, 3 Rue Jean Bouin, 30000 Nîmes, France.; Danti M; Radiology Unit, Madre Giuseppina Vannini Hospital, Via di Acqua Bullicante 4, 00177 Rome, Italy.; Sclafani M; Cardiology, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy.; Ansalone G; Cardiology Unit, Madre Giuseppina Vannini Hospital, Via di Acqua Bullicante 4, 00177 Rome, Italy.; Musumeci MB; Cardiology, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy.; Nagel E; Medical Faculty of Goethe University, Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt, Theodor-Stern-Kai 7, Germany.; Puntmann V; Medical Faculty of Goethe University, Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt, Theodor-Stern-Kai 7, Germany.; Sbarbati S; Radiology Unit, Madre Giuseppina Vannini Hospital, Via di Acqua Bullicante 4, 00177 Rome, Italy.; Cacciotti L; Cardiology Unit, Madre Giuseppina Vannini Hospital, Via di Acqua Bullicante 4, 00177 Rome, Italy. |
| Source: | European heart journal. Cardiovascular Imaging [Eur Heart J Cardiovasc Imaging] 2023 Jul 24; Vol. 24 (8), pp. 1082-1091. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Oxford University Press Country of Publication: England NLM ID: 101573788 Publication Model: Print Cited Medium: Internet ISSN: 2047-2412 (Electronic) Linking ISSN: 20472404 NLM ISO Abbreviation: Eur Heart J Cardiovasc Imaging Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Oxford : Oxford University Press |
| MeSH Terms: | Takotsubo Cardiomyopathy*/diagnostic imaging; Magnetic Resonance Imaging, Cine/methods ; Myocardium/pathology ; Edema/diagnostic imaging ; Edema/pathology ; Humans ; Female ; Middle Aged ; Aged ; Aged, 80 and over ; Male ; Stroke Volume ; Ventricular Function, Left ; Magnetic Resonance Spectroscopy ; Predictive Value of Tests ; Contrast Media |
| Abstract: | Aims: myocardial oedema is largely represented in takotsubo syndrome (TTS) and may contribute to alter the myocardium morphology and function. The aim of the study is to describe relationships between oedema, mechanical, and electrical abnormalities in TTS.; Methods and Results: the study included n = 32 hospitalized TTS patients and n = 23 controls. Cardiac magnetic resonance (CMR) with tissue mapping and feature tracking was performed with concomitant 12-lead electrocardiogram (ECG) recording. Mean age of TTS was 72 ± 12 years old, 94% women. Compared with controls, patients had higher left ventricular (LV) mass, worse systolic function, higher septal native T1 (1116 ± 73 msec vs. 970 ± 23 msec, P < 0.001), T2 (56 ± 5 msec vs. 46 ± 2 msec, P < 0.001), and extracellular volume (ECV) fraction (32 ± 5% vs. 24 ± 1%, P < 0.001). TTS patients had higher apicobasal gradient of T2 values (12 ± 6 msec vs. 2 ± 6 msec, P < 0.001); basal LV wall displayed higher native T1, T2, and ECV (all P < 0.002) but similar circumferential strain against controls (-23 ± 3% vs. -24 ± 4%, P = 0.351). In the TTS cohort, septal T2 values showed significant correlations with native T1 (r = 0.609, P < 0.001), ECV (r = 0.689, P < 0.001), left ventricular ejection fraction (r = -0.459, P = 0.008) and aVR voltage (r = -0.478, P = 0.009). Negative T-wave voltage and QTc length correlated with apicobasal T2 mapping gradient (r = 0.499, P = 0.007 and r = 0.372, P = 0.047, respectively) but not with other tissue mapping measurements.; Conclusions: CMR T1 and T2 mapping demonstrated increased myocardial water content conditioning interstitial expansion in acute TTS, detected even outside areas of abnormal wall motion. Oedema burden and distribution associated with mechanical and electrocardiographic changes, making it a potential prognostic marker and therapeutic target in TTS.; (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.) |
| Competing Interests: | Conflict of interest: None declared |
| Contributed Indexing: | Keywords: T1 mapping • T2 mapping • takotsubo • myocardial oedema • T-wave inversion • cardiac magnetic resonance imaging |
| Substance Nomenclature: | 0 (Contrast Media) |
| Entry Date(s): | Date Created: 20230302 Date Completed: 20230725 Latest Revision: 20230801 |
| Update Code: | 20260130 |
| DOI: | 10.1093/ehjci/jead035 |
| PMID: | 36861644 |
| Database: | MEDLINE |
Journal Article