Cardiac Magnetic Resonance Tissue-Tracking and Parametric Mapping in Characterizing Takotsubo Syndrome: A Pilot Study

Abstract Aims: The aims of our pilot study were to evaluate the application of cardiac magnetic resonance tissue tracking (CMR-TT) and tissue mapping in characterizing TS.Methods: Two groups were retrospectively enrolled: patients with apical ballooning TS (n=19) and healthy controls (n=10). We assessed global and regional bi-ventricular function, including longitudinal (LS), circumferential (CS), and radial strain (RS) analysis. Tissue characterization by T1, T2 mapping, and LGE was performed as well to detect the possible presence of myocardial injuries. Results: LS was reduced in patients with TS compared to healthy controls. LS dysfunction was detected mainly at mid- and apical cavity (p=0.001 for both). Again, basal RS was higher in TS patients compared to the control group. No other statistically significant differences in myocardial strain were detected. TS patients had higher T1 and T2 values, with greater involvement of the LV apex compared with controls. In a multivariate analysis, there was a statistically significant difference between TS and controls regarding parametric mapping and myocardial strain after controlling for gender and age. T1-native and T2 mapping proved to have an excellent performance in differentiating TS patients from controls (AUCs of 0.94 and 0.96, respectively)Conclusion: Our study suggests that myocardial strain impairment and parametric mappings could help in refining the evaluation of TS patients.