Cau Riccardo, Muscogiuri Giuseppe, Pisu Francesco, Gatti Marco, Velthuis Birgitta, Loewe Christian, Cademartiri Filippo, Pontone Gianluca, Montisci Roberta, Guglielmo Marco, Sironi Sandro, Esposito Antonio, Francone Marco, Dacher Nicholas, Peebles Charles, Bastarrika Gorka, Salgado Rodrigo, Saba Luca
Departments of Radiology.
School of Medicine and Surgery, University of Milano-Bicocca.
J Thorac Imaging. 2023 Nov 1;38(6):391-398. doi: 10.1097/RTI.0000000000000709. Epub 2023 Apr 4.
Takotsubo cardiomyopathy (TTC) is a transient but severe acute myocardial dysfunction with a wide range of outcomes from favorable to life-threatening. The current risk stratification scores of TTC patients do not include cardiac magnetic resonance (CMR) parameters. To date, it is still unknown whether and how clinical, trans-thoracic echocardiography (TTE), and CMR data can be integrated to improve risk stratification.
EVOLUTION (Exploring the eVolution in prognOstic capabiLity of mUlti-sequence cardiac magneTIc resOnance in patieNts affected by Takotsubo cardiomyopathy) is a multicenter, international registry of TTC patients who will undergo a clinical, TTE, and CMR evaluation. Clinical data including demographics, risk factors, comorbidities, laboratory values, ECG, and results from TTE and CMR analysis will be collected, and each patient will be followed-up for in-hospital and long-term outcomes. Clinical outcome measures during hospitalization will include cardiovascular death, pulmonary edema, arrhythmias, stroke, or transient ischemic attack.Clinical long-term outcome measures will include cardiovascular death, pulmonary edema, heart failure, arrhythmias, sudden cardiac death, and major adverse cardiac and cerebrovascular events defined as a composite endpoint of death from any cause, myocardial infarction, recurrence of TTC, transient ischemic attack, and stroke. We will develop a comprehensive clinical and imaging score that predicts TTC outcomes and test the value of machine learning models, incorporating clinical and imaging parameters to predict prognosis.
The main goal of the study is to develop a comprehensive clinical and imaging score, that includes TTE and CMR data, in a large cohort of TTC patients for risk stratification and outcome prediction as a basis for possible changes in patient management.
应激性心肌病（TTC）是一种短暂但严重的急性心肌功能障碍，其预后范围广泛，从良好到危及生命。目前TTC患者的风险分层评分未纳入心脏磁共振成像（CMR）参数。迄今为止，临床、经胸超声心动图（TTE）和CMR数据能否以及如何整合以改善风险分层仍不清楚。
EVOLUTION（探索多序列心脏磁共振成像在应激性心肌病患者中的预后能力演变）是一项针对将接受临床、TTE和CMR评估的TTC患者的多中心国际注册研究。将收集包括人口统计学、危险因素、合并症、实验室检查值、心电图以及TTE和CMR分析结果在内的临床数据，并对每位患者进行住院期间和长期预后随访。住院期间的临床结局指标将包括心血管死亡、肺水肿、心律失常、中风或短暂性脑缺血发作。临床长期结局指标将包括心血管死亡、肺水肿、心力衰竭、心律失常、心源性猝死以及定义为任何原因导致的死亡、心肌梗死、TTC复发、短暂性脑缺血发作和中风的复合终点的重大不良心脑血管事件。我们将制定一个预测TTC结局的综合临床和影像评分，并测试纳入临床和影像参数以预测预后的机器学习模型的价值。
该研究主要目标是在一大群TTC患者中制定一个综合临床和影像评分，该评分纳入TTE和CMR数据，用于风险分层和结局预测，作为可能改变患者管理方式的依据。
