Atrial mechanics and their prognostic impact in Takotsubo syndrome: a cardiovascular magnetic resonance imaging study
- 10 January 2019
- journal article
- research article
- Published by Oxford University Press (OUP) in European Heart Journal – Cardiovascular Imaging
- Vol. 20 (9), 1059-1069
- https://doi.org/10.1093/ehjci/jey219
Abstract
Aims: The exact pathophysiology of Takotsubo syndrome (TTS) remains not fully understood with most studies focussing on ventricular pathology. Since atrial involvement may have a significant role, we assessed the diagnostic and prognostic potential of atrial cardiovascular magnetic resonance feature tracking (CMR-FT) in TTS.Methods and results: This multicentre study recruited 152 TTS patients who underwent CMR on average within 3 days after hospitalization. Reservoir [total strain εs and peak positive strain rate (SR) SRs], conduit (passive strain εe and peak early negative SRe), and booster pump function (active strain εa and peak late negative SRa) were assessed in a core laboratory. Results were compared with 21 control patients with normal biventricular function. A total of 20 patients underwent follow-up CMR (median 3.5 months, interquartile range 3–5). All patients were approached for general follow-up. Left atrial (LA) but not right atrial (RA) reservoir and conduit function were impaired during the acute phase (εs: P = 0.043, εe: P < 0.001, SRe: P = 0.047 vs. controls) and recovered until follow-up (εs: P < 0.001, SRs: P = 0.04, εe: P = 0.001, SRe: P = 0.04). LA and RA booster pump function were increased in the acute setting (LA-εa: P = 0.045, SRa: P = 0.002 and RA-εa: P = 0.004, SRa: P = 0.002 vs. controls). LA-εs predicted mortality [hazard ratio 1.10, 95% confidence interval (CI) 1.01–1.20; P = 0.037] irrespectively of established cardiovascular risk factors (P = 0.019, multivariate analysis) including left ventricular ejection fraction (LVEF) (area under the curve 0.71, 95% CI 0.55–0.86, P = 0.048).Conclusion: TTS pathophysiology comprises transient impairments in LA reservoir and conduit functions and enhanced bi-atrial active booster pump functions. Atrial CMR-FT may evolve as a superior marker of adverse events over and above established parameters such as LVEF and atrial volume.Funding Information
- DZHK—Deutsches Zentrum für Herz-Kreislauf-Forschung eV
This publication has 45 references indexed in Scilit:
- Inter-study reproducibility of cardiovascular magnetic resonance myocardial feature trackingJournal of Cardiovascular Magnetic Resonance, 2012
- Left atrial strain is related to adverse events in patients after acute myocardial infarction treated with primary percutaneous coronary interventionHeart, 2011
- Prognostic Significance of Myocardial Fibrosis in Hypertrophic CardiomyopathyJournal of the American College of Cardiology, 2010
- Comparison of Magnetic Resonance Feature Tracking for Strain Calculation With Harmonic Phase Imaging AnalysisJACC: Cardiovascular Imaging, 2010
- Cardiovascular Magnetic ResonanceCirculation, 2010
- Natural History and Expansive Clinical Profile of Stress (Tako-Tsubo) CardiomyopathyJournal of the American College of Cardiology, 2010
- Increased Atrial Contribution to Left Ventricular Filling Compensates for Impaired Early Filling During Exercise in Heart Failure With Preserved Ejection FractionJournal of Cardiac Failure, 2009
- Right ventricular involvement in Takotsubo cardiomyopathyEuropean Heart Journal, 2006
- Left Atrial VolumeCirculation, 2003