Late gadolinium enhancement was present in 21% of TTS patients and associated with higher in-hospital MACE (38.5% vs 11.4%, p=0.024) and worse clinical profile.
Does the presence of late gadolinium enhancement on early CMR predict in-hospital MACE in patients with Takotsubo syndrome?
The presence of late gadolinium enhancement on early CMR in patients with Takotsubo syndrome is associated with a worse clinical profile and a significantly higher rate of in-hospital adverse events.
Absolute Event Rate: 0% vs 0%
Abstract Background Takotsubo syndrome (TTS) is a clinical syndrome characterized by acute and transient ventricular dysfunction, often triggered by emotional or physical stress. Cardiac magnetic resonance (CMR) has emerged as a first-line method for advanced non-invasive evaluation of TTS for assessing ventricle function, myocardial edema, late gadolinium enhancement (LGE) and complications. To date, the presence and characteristics of LGE in TTS patients are controversial and still under investigation. Purpose To evaluate the presence of LGE at early CMR in patients with TTS and its impact on in-hospital events. Methods In our study we evaluated consecutive patients hospitalized for TTS between 2016 and 2021. Diagnosis of TTS was based on the international Takotsubo diagnostic criteria (InterTAK Diagnostic Criteria). Based on the presence of LGE patients were categorized in LGE+ group and LGE- group. In hospital MACE included all-cause mortality, arrhythmias and heart failure (defined as development of Killip class III or IV). Results Among 127 patients admitted for TTS, early CMR was available in 67 patients during hospitalization (mean 7.5 ± 3.7 days). The mean age was 68.7 ± 11.1 years, with 81% being female. Emotional and physical stress triggers were reported in 44% and 56% of patients, respectively. CMR confirmed typical apical ballooning in 87% of patients, with only 4.5% exhibiting a midventricular pattern. LGE+ group included 14 patients and LGE- group 52. LGE+ group displayed a patchy distribution, primarily in the lateral (11.9%) and inferior segments (10.4%). Notably, LGE was more frequent in patients experiencing physical stress as a trigger (38.1% vs. 13%; p=0.04). Left ventricular ejection fraction was lower in the LGE+ group (53 ± 12.3 vs. 43.3 ± 7.7; p=0.06), showing a trend toward significance. LGE + group also presented more frequently ST-segment elevation (15% vs. 44%; p=0.04) at presentation. Moreover in-hospital MACE was significant more frequently in LGE + population (38.5% vs 11.4%, p=0.024). Conclusions LGE is not a common finding in TTS patients and its prognostic role remains unclear. In our population patients with LGE show a worse clinical profile with higher in-hospital events. Further studies are needed to understand the pathophysiological significance of LGE in TTS and to assess its prognostic role in short and long-term outcomes.
Impellizzeri et al. (Sat,) reported a other. Late gadolinium enhancement was present in 21% of TTS patients and associated with higher in-hospital MACE (38.5% vs 11.4%, p=0.024) and worse clinical profile.