Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome - Policlinico Umberto I Hospital, Viale Regina Elena 324, Rome, 00183, Italy.
Eur Radiol Exp. 2024 Feb 28;8(1):34. doi: 10.1186/s41747-024-00423-7.
We investigated the differences in impairment of left ventricle (LV) and left atrium (LA) contractile dysfunction between subacute and convalescent takotsubo syndrome (TTS), using myocardial strain analysis by cardiac magnetic resonance (CMR) feature-tracking technique.
We retrospectively selected 50 patients with TTS clinical-radiological diagnosis who underwent CMR within 30 days since symptoms onset: 19 studied during the early subacute phase (sTTS, ≤ 7 days) and 31 during the convalescence (cTTS, 8-30 days). We measured the following: LV global longitudinal, circumferential, and radial strain (lvGLS, lvGCS, lvGRS) and strain rate (SR) and LA reservoir (laS_r), conduit (laS_cd), and booster pump strain (laS_bp) and strain rate (laSR_r, laSR_cd, laSR_bp). Patients were compared with 30 age- and sex-matched controls.
All patients were women (mean age 63 years). TTS patients showed altered LV- and LA-strain features, compared to controls. sTTS was associated with increased laS_bp (12.7% versus 9.8%) and reduced lvEF (47.4% versus 54.8%), lvGLS (-12.2% versus 14.6%), and laS_cd (7.0% versus 9.5%) compared to cTTS (p ≤ 0.029). The interval between symptoms onset and CMR was correlated with laS_bp (r = -0.49) and lvGLS (r = 0.47) (p = 0.001 for both). At receiver operating characteristics analysis, laS_bp was the best discriminator between sTTS and cTTS (area under the curve [AUC] 0.815), followed by lvGLS (AUC 0.670).
LA dysfunction persists during the subacute and convalescence of TTS. laS_bp increases in subacute phase with progressive decrease during convalescence, representing a compensatory mechanism of LV dysfunction and thus a useful index of functional recovery.
Atrial strain has the potential to enhance the delineation of cardiac injury and functional impairment in TTS patients, assisting in the identification of individuals at higher risk and facilitating the implementation of more targeted and personalized medical therapies.
• In TTS, after ventricular recovery, atrial dysfunction persists assessable with CMR feature tracking. • Quantitative assessment of atrial strain discriminates atrial functions: reservoir, conduit, and booster pump. • Atrial booster pump changes after acute TTS, regardless of ventricular function. • Atrial strain may serve as a temporal marker in TTS.
我们通过心脏磁共振（CMR）特征追踪技术，研究了亚急性期和恢复期心尖球形综合征（TTS）左心室（LV）和左心房（LA）收缩功能障碍的差异。
我们回顾性选择了 50 例 TTS 临床-影像学诊断患者，这些患者在症状发作后 30 天内接受了 CMR：19 例在早期亚急性期（sTTS，≤7 天）进行研究，31 例在恢复期（cTTS，8-30 天）进行研究。我们测量了以下参数：LV 整体纵向、圆周和径向应变（lvGLS、lvGCS、lvGRS）和应变率（SR）以及 LA 储器（laS_r）、导管（laS_cd）和助推泵应变（laS_bp）和应变率（laSR_r、laSR_cd、laSR_bp）。患者与 30 名年龄和性别匹配的对照者进行了比较。
所有患者均为女性（平均年龄 63 岁）。与对照组相比，TTS 患者的 LV 和 LA 应变特征发生了改变。sTTS 与 LA 助推泵应变（12.7% vs 9.8%）和左心室射血分数（EF）降低（47.4% vs 54.8%）、lvGLS（-12.2% vs 14.6%）和 LA 导管应变（7.0% vs 9.5%）有关，与 cTTS 相比（p≤0.029）。症状发作和 CMR 之间的时间间隔与 laS_bp（r=-0.49）和 lvGLS（r=-0.47）相关（p 值均为 0.001）。在受试者工作特征曲线分析中，laS_bp 是区分 sTTS 和 cTTS 的最佳鉴别指标（曲线下面积[AUC]为 0.815），其次是 lvGLS（AUC 为 0.670）。
LA 功能障碍在 TTS 的亚急性期和恢复期持续存在。亚急性期 LA 应变增加，随着恢复期的进展逐渐减少，代表 LV 功能障碍的代偿机制，因此是功能恢复的有用指标。
在 TTS 患者中，心房应变有可能增强对心脏损伤和功能障碍的描述，有助于识别风险较高的个体，并促进更有针对性和个性化的医疗治疗。
在 TTS 中，心室恢复后，心房功能仍可通过 CMR 特征追踪进行评估。
心房应变的定量评估可区分心房功能：储器、导管和助推泵。
急性 TTS 后，无论心室功能如何，心房助推泵都会发生变化。
心房应变可能是 TTS 的时间标志物。
