Cardiology Unit, Madre Giuseppina Vannini Hospital, Via di Acqua Bullicante 4, 00177 Rome, Italy.
Radiology Unit, Madre Giuseppina Vannini Hospital, Via di Acqua Bullicante 4, 00177 Rome, Italy.
Eur Heart J Cardiovasc Imaging. 2023 Jul 24;24(8):1082-1091. doi: 10.1093/ehjci/jead035.
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.
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.
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.
心肌水肿在应激性心肌病（TTS）中大量存在，并可能导致心肌形态和功能改变。本研究旨在描述 TTS 中心包水肿、机械和电异常之间的关系。
该研究纳入了 32 名住院 TTS 患者和 23 名对照组患者。使用心脏磁共振（CMR）组织映射和特征跟踪技术，同时记录 12 导联心电图（ECG）。TTS 患者的平均年龄为 72±12 岁，94%为女性。与对照组相比，患者的左心室（LV）质量更高，收缩功能更差，室间隔固有 T1 值更高（1116±73ms 比 970±23ms，P＜0.001），T2 值更高（56±5ms 比 46±2ms，P＜0.001），细胞外容积（ECV）分数更高（32±5%比 24±1%，P＜0.001）。TTS 患者的 T2 值心尖-基底梯度更高（12±6ms 比 2±6ms，P＜0.001）；LV 基底壁显示固有 T1、T2 和 ECV 更高（均 P＜0.002），但与对照组相比，周向应变相似（-23±3%比-24±4%，P=0.351）。在 TTS 队列中，室间隔 T2 值与固有 T1 值（r=0.609，P＜0.001）、ECV（r=0.689，P＜0.001）、左心室射血分数（r=-0.459，P=0.008）和 aVR 电压（r=-0.478，P=0.009）呈显著相关。负 T 波电压和 QTc 长度与心尖-基底 T2 映射梯度相关（r=0.499，P=0.007 和 r=0.372，P=0.047），但与其他组织映射测量无关。
CMR T1 和 T2 映射显示，急性 TTS 中心肌含水量增加导致间质扩张，即使在异常壁运动区域之外也能检测到。水肿负荷和分布与机械和心电图变化相关，使其成为 TTS 的潜在预后标志物和治疗靶点。
