Prognostic Value of Different CMR-Based Techniques to Assess Left Ventricular Myocardial Strain in Takotsubo Syndrome

Thomas Stiermaier, Kira Busch, Torben Lange, Toni Pätz, Moritz Meusel, Sören J Backhaus, Alex Frydrychowicz, Jörg Barkhausen, Matthias Gutberlet, Holger Thiele, Andreas Schuster, Ingo Eitel

    Abstract

    Cardiac magnetic resonance (CMR)-derived left ventricular (LV) global longitudinal strain (GLS) provides incremental prognostic information on various cardiovascular diseases but has not yet been investigated comprehensively in patients with Takotsubo syndrome (TS). This study evaluated the prognostic value of feature tracking (FT) GLS, tissue tracking (TT) GLS, and fast manual long axis strain (LAS) in 147 patients with TS, who underwent CMR at a median of 2 days after admission. Long-term mortality was assessed 3 years after the acute event. In contrast to LV ejection fraction and tissue characteristics, impaired FT-GLS, TT-GLS and fast manual LAS were associated with adverse outcome. The best cutoff points for the prediction of long-term mortality were similar with all three approaches: FT-GLS -11.28%, TT-GLS -11.45%, and fast manual LAS -10.86%. Long-term mortality rates were significantly higher in patients with FT-GLS > -11.28% (25.0% versus 9.8%; p = 0.029), TT-GLS > -11.45% (20.0% versus 5.4%; p = 0.016), and LAS > -10.86% (23.3% versus 6.6%; p = 0.014). However, in multivariable analysis, diabetes mellitus (p = 0.001), atrial fibrillation (p = 0.001), malignancy (p = 0.006), and physical triggers (p = 0.006) outperformed measures of myocardial strain and emerged as the strongest, independent predictors of long-term mortality in TS. In conclusion, CMR-based longitudinal strain provides valuable prognostic information in patients with TS, regardless of the utilized technique of assessment. Long-term mortality, however, is mainly determined by comorbidities.

    Original languageEnglish
    JournalJournal of Clinical Medicine
    Volume9
    Issue number12
    ISSN2077-0383
    DOIs
    Publication statusPublished - 29.11.2020

    Research Areas and Centers

    • Centers: Cardiological Center Luebeck (UHZL)

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