Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Bonn, Germany.
Eur Radiol. 2023 Aug;33(8):5498-5508. doi: 10.1007/s00330-023-09543-x. Epub 2023 Mar 23.
To find simple imaging-based features on cardiac magnetic resonance (CMR) that are associated with major adverse cardiovascular events (MACE) in takotsubo syndrome (TTS).
Patients with TTS referred for CMR between 2007 and 2021 were retrospectively evaluated. Besides standard CMR analysis, commonly known complications of TTS based on expert knowledge were assessed and summarised via a newly developed PERT score (one point each for pleural effusion, pericardial effusion, right ventricular involvement, and ventricular thrombus). Clinical follow-up data was reviewed up to three years after discharge. The relationship between PERT features and the occurrence of MACE (cardiovascular death or new hospitalisation due to acute myocardial injury, arrhythmia, or chronic heart failure) was examined using Cox regression analysis and Kaplan-Meier estimator.
Seventy-nine patients (mean age, 68 ± 14 years; 72 women) with TTS were included. CMR was performed in a median of 4 days (IQR, 2-6) after symptom onset. Over a median follow-up of 13.3 months (IQR, 0.4-36.0), MACE occurred in 14/79 (18%) patients: re-hospitalisation due to acute symptoms (9/79, 11%) or chronic heart failure symptoms (4/79, 5%), and cardiac death (1/79, 1%). Patients with MACE had a higher PERT score (median [IQR], 2 [2-3] vs 1 [0-1]; p < 0.001). PERT score was associated with MACE on Cox regression analysis (hazard ratio per PERT feature, 2.44; 95%CI: 1.62-3.68; p < 0.001). Two or more PERT complications were strongly associated with the occurrence of MACE (log-rank p < 0.001).
The introduced PERT complication score might enable an easy-to-assess outcome evaluation of TTS patients by CMR.
• Complications like pericardial effusion, pleural effusion, right ventricular involvement, and ventricular thrombus (summarised as PERT features) are relatively common in takotsubo syndrome. • The proposed PERT score (one point per complication) was associated with the occurrence of major adverse cardiac events on follow-up. • Complications easily detected by cardiac magnetic resonance imaging can help clinicians derive long-term prognostic information on patients with takotsubo syndrome.
寻找心脏磁共振（CMR）上与应激性心肌病（TTS）主要不良心血管事件（MACE）相关的简单影像学特征。
回顾性评估了 2007 年至 2021 年间因 TTS 接受 CMR 检查的患者。除了标准的 CMR 分析外，还根据专家知识评估了 TTS 常见并发症，并通过新开发的 PERT 评分（胸腔积液、心包积液、右心室受累和心室血栓各 1 分）进行总结。对出院后 3 年内的临床随访数据进行了回顾。使用 Cox 回归分析和 Kaplan-Meier 估计器检查 PERT 特征与 MACE（心血管死亡或因急性心肌损伤、心律失常或慢性心力衰竭而再次住院）发生之间的关系。
共纳入 79 例 TTS 患者（平均年龄 68±14 岁；72 名女性）。CMR 在症状发作后中位 4 天（IQR，2-6）进行。中位随访 13.3 个月（IQR，0.4-36.0）后，79 例患者中有 14 例（18%）发生 MACE：因急性症状（9/79，11%）或慢性心力衰竭症状（4/79，5%）再次住院，以及心脏性死亡（1/79，1%）。发生 MACE 的患者 PERT 评分更高（中位数[IQR]，2[2-3]比 1[0-1]；p<0.001）。PER 评分与 Cox 回归分析中的 MACE 相关（每个 PERT 特征的风险比，2.44；95%CI：1.62-3.68；p<0.001）。两个或更多 PERT 并发症与 MACE 的发生强烈相关（对数秩检验 p<0.001）。
该研究提出的 PERT 并发症评分可以通过 CMR 对 TTS 患者的预后进行简便评估。
心包积液、胸腔积液、右心室受累和心室血栓等并发症（总结为 PERT 特征）在应激性心肌病中较为常见。
提出的 PERT 评分（每个并发症 1 分）与随访期间发生的主要不良心脏事件相关。
CMR 容易检测到的并发症可以帮助临床医生为应激性心肌病患者提供长期预后信息。
