Humayra Syeda, Yahya Noorazrul, Ning Chai Jia, Mir Imtiyaz Ali, Mohamed Abdul Latiff, Manan Hanani Abdul
Makmal Pemprosesan Imej Kefungsian (Functional Image Processing Laboratory), Department of Radiology, University Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia.
Diagnostic Imaging & Radiotherapy Program, School of Diagnostic & Applied Health Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia.
Heliyon. 2024 Apr 16;10(9):e29755. doi: 10.1016/j.heliyon.2024.e29755. eCollection 2024 May 15.
Current imaging advancements quantify the use of cardiovascular magnetic resonance (CMR) derived T1 and T2 tissue characterization as robust indicators for cardiomyopathies, but limited literature exists on its clinical application in Takotsubo syndrome (TTS). This systematic review evaluated the T1 and T2 parametric mapping to delineate the current diagnostic and prognostic CMR imaging outcomes in TTS.
A comprehensive literature search until October 2023 was performed on ScienceDirect, PubMed, Web of Science, and Cochrane Library by two independent reviewers adhering to the PRISMA framework. The Newcastle-Ottawa Scale (NOS) was used to evaluate the methodological quality of studies.
Out of 198 results, 8 studies were included in this qualitative synthesis, accounting for a total population of 399 subjects (TTS = 201, controls = 175, acute myocarditis = 14, and acute regional myocardial oedema without infarction = 9). Approximately 50.4 % were TTS patients aged between 61 and 73 years, whereof, females (n = 181, 90.0 %) and apical variants (n = 180, 89.6 %) were significantly higher, and emotional stressor (n = 42; 20.9 %) was more prevalent than physical (n = 27; 13.4 %). The NOS identified 62.5 % of studies as moderate and 37.5 % as high quality. Parametric tissue mapping revealed significantly prolonged T1 and T2 relaxation times at 1.5T and 3T respectively in TTS (1053-1164 msec, 1292-1438 msec; and 56-67 msec, 60-90 msec) with higher extracellular volume (ECV) fraction (29-36 %), compared to healthy subjects (944-1211 msec, 1189-1251 msec; and 46-54 msec, 32-68 msec; 23-29 %) and myocarditis (1058 msec, 60 msec). Other significant myocardial abnormalities included increased left ventricular (LV) end-systolic and diastolic volume and reduced global longitudinal strain. Overall, myocardial oedema, altered LV mass and strain, and worse LV systolic function, with higher native T1, T2, and ECV values were consistent.
Future research with substantially larger clinical trials is vital to explore the CMR imaging findings in diverse TTS patient cohorts and correlate the T1 and T2 mapping outcomes with demographic/clinical covariates. CMR is a valuable imaging tool for TTS diagnosis and prognostication. T1 and T2 parametric mapping facilitates the quantification of oedema, inflammation, and myocardial injury in Takotsubo.
当前的成像技术进步将心血管磁共振（CMR）衍生的T1和T2组织特征定量分析作为心肌病的可靠指标，但关于其在Takotsubo综合征（TTS）临床应用的文献有限。本系统评价评估了T1和T2参数成像，以描绘TTS目前的诊断和预后CMR成像结果。
两名独立审稿人按照PRISMA框架，于2023年10月前在ScienceDirect、PubMed、Web of Science和Cochrane图书馆进行了全面的文献检索。采用纽卡斯尔-渥太华量表（NOS）评估研究的方法学质量。
在198项结果中，8项研究纳入了本定性分析，共涉及399名受试者（TTS = 201名，对照组 = 175名，急性心肌炎 = 14名，急性局灶性心肌水肿无梗死 = 9名）。约50.4%为61至73岁的TTS患者，其中女性（n = 181名，90.0%）和心尖部病变（n = 180名，89.6%）显著更多，情绪应激源（n = 42；20.9%）比身体应激源（n = 27；13.4%）更常见。NOS将62.5%的研究评定为中等质量，37.5%为高质量。参数组织成像显示，TTS患者在1.5T和3T时T1和T2弛豫时间分别显著延长（1053 - 1164毫秒，1292 - 1438毫秒；以及56 - 67毫秒，60 - 最大90毫秒），细胞外容积（ECV）分数更高（29 - 36%），与健康受试者（944 - 1211毫秒，1189 - 1251毫秒；以及46 - 54毫秒，32 - 68毫秒；23 - 29%）和心肌炎患者（1058毫秒，60毫秒）相比。其他显著的心肌异常包括左心室（LV）收缩末期和舒张末期容积增加以及整体纵向应变降低。总体而言，心肌水肿、LV质量和应变改变以及LV收缩功能较差，同时T1、T2和ECV值较高是一致的。
未来开展规模更大的临床试验对于探索不同TTS患者队列中的CMR成像结果，并将T1和T2成像结果与人口统计学/临床协变量相关联至关重要。CMR是用于TTS诊断和预后评估的有价值的成像工具。T1和T2参数成像有助于量化Takotsubo综合征中的水肿、炎症和心肌损伤。
