Cardiac magnetic resonance in patients with Takotsubo syndrome: Clinical correlates of T2 mapping

Background: Extensive myocardial edema is a key feature of acute takotsubo syndrome (TTS) and it can be quantitatively assessed by T2 mapping cardiac magnetic resonance (CMR) imaging. Clinical correlates of myocardial edema in TTS are not well characterized.

Methods: Sixty patients with acute TTS underwent CMR with T2 mapping within one week of hospitalization. Disease severity was assessed by a validated risk score (GEIST-score).

Results: Mean age of the study population was 71 ± 12 years (92 % females). Mean mid-septal T2 time was 58 ± 6 ms. Higher T2 mapping values were found in patients with left ventricular ejection fraction (LVEF) ≤40 % (60 ± 6 ms vs 56 ± 5 ms; p = 0.006), male sex (66 ± 7 ms vs 58 ± 6 ms; p = 0.010), dyspnea on admission (63 ± 7 ms vs 58 ± 6 ms; p = 0.006), absence of an emotional trigger (60 ± 7 ms vs 57 ± 5 ms; p = 0.039), intermediate-to-severe GEIST-score (63 ± 7 ms vs 58 ± 6 ms; p = 0.045) and in-hospital complications (61 ± 1 ms vs 58 ± 6 ms; p = 0.009). A trend towards higher values was observed in patients who died at follow-up (62 ± 8 ms vs 58 ± 6 ms; p = 0.098). On linear regression analysis, T2 mapping did not correlate with the timing of CMR (Beta -0.182, p = 0.170), whereas after multivariable correction, lack of emotional trigger (Beta 0.262, p = 0.031), decreasing LVEF (Beta -0.254, p = 0.024) and increasing GEIST score (Beta 0.282, p = 0.024) remained independently associated with T2 mapping.

Conclusions: In patients with acute TTS undergoing a timely CMR within the first week after admission, T2 mapping was not affected by timing of the examination, was higher in patients displaying high-risk features, and independently associated with the GEIST risk score.