Cau Riccardo, Pitzalis Carolina, Pisu Francesco, Mantini Cesare, Pontone Gianluca, Marchetti Maria Francesca, Montisci Roberta, Salgado Rodrigo, Esposito Antonio, Saba Luca
Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari-Polo di Monserrato s.s. 554 Monserrato (Cagliari), Cagliari, 09045, Italy.
Department of Neuroscience, Imaging, and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy.
Eur Radiol. 2025 Jan 22. doi: 10.1007/s00330-024-11340-z.
The purpose of this study was to explore microvascular function impairment using first-pass cardiovascular magnetic resonance (CMR) in patients with Takotsubo syndrome (TS). Moreover, we explored myocardial microcirculation in patients with TS and related this to demographic data, cardiovascular risk factors, clinical parameters, cardiac biomarkers, and cardiac function.
This retrospective study performed CMR first-pass perfusion scans in 42 consecutive patients with TS (37 females, 70.6 ± 9.4 years). Moreover, we included 44 sex- and age-matched healthy controls (33 females, 66.4 ± 10.5 years). CMR-derived myocardial microcirculation function was analyzed and compared between TS patients and controls.
Compared to age-, sex-, and cardiovascular risk factors-matched control group, TS patients demonstrated a lower perfusion index (PI) (0.140 ± 0.060 vs. 0.182 ± 0.056, p = 0.001). In multivariable analysis with adjustment for demographic data and cardiovascular risk factors, an impairment in PI was independently associated with left ventricle ejection fraction (β coefficient = 3.793, p = 0.001) and T2 mapping (β coefficient = -4.316, p = 0.001).
TS patients exhibited myocardial microvascular dysfunction, which was non-invasively assessed using first-pass CMR. This impaired myocardial microvascular function was found to be independently associated with left ventricular ejection fraction and myocardial edema.
Question Can cardiovascular magnetic resonance (CMR) cardiac MR first-pass perfusion help to better understand Takotsubo pathophysiology by exploring microvascular impairment? Findings CMR first-pass perfusion revealed significant microvascular dysfunction during the acute phase of Takotsubo syndrome, independently associated with left ventricular ejection fraction and myocardial edema. Clinical relevance Identifying an abnormal microvascular network using non-invasive biomarkers could enhance risk stratification and guide tailored management during the acute phase of Takotsubo syndrome.
本研究旨在利用首过心血管磁共振成像（CMR）探讨应激性心肌病（TS）患者的微血管功能损害情况。此外，我们还探究了TS患者的心肌微循环，并将其与人口统计学数据、心血管危险因素、临床参数、心脏生物标志物及心功能进行关联分析。
本回顾性研究对42例连续的TS患者（37例女性，年龄70.6±9.4岁）进行了CMR首过灌注扫描。此外，我们纳入了44例年龄和性别匹配的健康对照者（33例女性，年龄66.4±10.5岁）。对TS患者和对照者的CMR衍生心肌微循环功能进行分析和比较。
与年龄、性别和心血管危险因素匹配的对照组相比，TS患者的灌注指数（PI）较低（0.140±0.060 vs. 0.182±0.056，p = 0.001）。在对人口统计学数据和心血管危险因素进行校正的多变量分析中，PI受损与左心室射血分数（β系数 = 3.793，p = 0.001）和T2映射（β系数 = -4.316，p = 0.001）独立相关。
TS患者表现出心肌微血管功能障碍，可通过首过CMR进行无创评估。发现这种受损的心肌微血管功能与左心室射血分数和心肌水肿独立相关。
问题 心血管磁共振成像（CMR）心脏磁共振首过灌注能否通过探究微血管损害来更好地理解应激性心肌病的病理生理学？ 发现 CMR首过灌注显示应激性心肌病急性期存在明显的微血管功能障碍，与左心室射血分数和心肌水肿独立相关。 临床意义 使用无创生物标志物识别异常微血管网络可加强风险分层，并指导应激性心肌病急性期的个体化管理。
