Stiermaier Thomas, Busch Kira, Lange Torben, Pätz Toni, Meusel Moritz, Backhaus Sören J, Frydrychowicz Alex, Barkhausen Jörg, Gutberlet Matthias, Thiele Holger, Schuster Andreas, Eitel Ingo
Medical Clinic II, University Heart Center Luebeck, 23538 Luebeck, Germany.
German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, 23538 Luebeck, Germany.
J Clin Med. 2020 Nov 29;9(12):3882. doi: 10.3390/jcm9123882.
Cardiac magnetic resonance (CMR)-derived left ventricular (LV) global longitudinal strain (GLS) provides incremental prognostic information on various cardiovascular diseases but has not yet been investigated comprehensively in patients with Takotsubo syndrome (TS). This study evaluated the prognostic value of feature tracking (FT) GLS, tissue tracking (TT) GLS, and fast manual long axis strain (LAS) in 147 patients with TS, who underwent CMR at a median of 2 days after admission. Long-term mortality was assessed 3 years after the acute event. In contrast to LV ejection fraction and tissue characteristics, impaired FT-GLS, TT-GLS and fast manual LAS were associated with adverse outcome. The best cutoff points for the prediction of long-term mortality were similar with all three approaches: FT-GLS -11.28%, TT-GLS -11.45%, and fast manual LAS -10.86%. Long-term mortality rates were significantly higher in patients with FT-GLS > -11.28% (25.0% versus 9.8%; = 0.029), TT-GLS > -11.45% (20.0% versus 5.4%; = 0.016), and LAS > -10.86% (23.3% versus 6.6%; = 0.014). However, in multivariable analysis, diabetes mellitus ( = 0.001), atrial fibrillation ( = 0.001), malignancy ( = 0.006), and physical triggers ( = 0.006) outperformed measures of myocardial strain and emerged as the strongest, independent predictors of long-term mortality in TS. In conclusion, CMR-based longitudinal strain provides valuable prognostic information in patients with TS, regardless of the utilized technique of assessment. Long-term mortality, however, is mainly determined by comorbidities.
心脏磁共振成像（CMR）衍生的左心室（LV）整体纵向应变（GLS）为各种心血管疾病提供了额外的预后信息，但尚未在应激性心肌病（TS）患者中进行全面研究。本研究评估了147例TS患者的特征跟踪（FT）GLS、组织跟踪（TT）GLS和快速手动长轴应变（LAS）的预后价值，这些患者在入院后中位数2天接受了CMR检查。在急性事件发生3年后评估长期死亡率。与左心室射血分数和组织特征不同，FT-GLS、TT-GLS和快速手动LAS受损与不良预后相关。三种方法预测长期死亡率的最佳截断点相似：FT-GLS为-11.28%，TT-GLS为-11.45%，快速手动LAS为-10.86%。FT-GLS > -11.28%的患者长期死亡率显著更高（25.0%对9.8%；P = 0.029），TT-GLS > -11.45%的患者（20.0%对5.4%；P = 0.016），以及LAS > -10.86%的患者（23.3%对6.6%；P = 0.014）。然而，在多变量分析中，糖尿病（P = 0.001）、心房颤动（P = 0.001）、恶性肿瘤（P = 0.006）和身体触发因素（P = 0.006）在预测长期死亡率方面优于心肌应变测量指标，并成为TS患者长期死亡率最强的独立预测因素。总之，基于CMR的纵向应变在TS患者中提供了有价值的预后信息，无论采用何种评估技术。然而，长期死亡率主要由合并症决定。
