Novel Imaging and Genetic Risk Markers in Takotsubo Syndrome

Figures

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  Figure 1. Bull-eye depicting longitudinal strain of the LV by speckle tracking echocardiography in a patient with previous TTS at 1-month follow-up after the acute event. Despite complete recovery of LVEF, longitudinal systolic function is still impaired (global longitudinal strain −13.6%).

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  Figure 2. (A) Left ventriculogram demonstrating apical ballooning of the left ventricle; (B) Echo-PIV analysis, revealing the presence of a single vortex, occupying the center of the left ventricle and non-interacting with others (arrow). (C,D) PIV derived polar histograms showing a relatively preserved base-apex flow direction. Adapted with permissions from Cimino et al. (43). Particle image velocimetry (PIV), left ventricle (LV), left atrium (LA), aorta (Ao).

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  Figure 3. Frames taken from cardiac magnetic resonance cine imaging. Top row, end-diastolic (A) and end-systolic (B) frames depict apical ballooning of the left ventricles (white arrows in B). Bottom row, end-diastolic (C) and end-systolic (D) frames depict mid-ventricular ballooning of the left ventricles (white arrows in D).

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  Figure 4. Cardiac magnetic resonance mapping images depicting myocardial edema in the acute phase of TTS. Mid-apical circumferential edema of the left ventricle is visualized as areas of higher intensity from the T2 mapping image (white arrows in A). Parametric quantification of native T1 and T2 values is better performed from the mid short-axis view by drawing a conservative region of interest (ROI) within the interventricular septum. Native T1 (MOLLI) (B) and T2 (C) shows a parallel increase at 1,152 and 56 ms, respectively. Extra-cellular volume (ECV) fraction was calculated from native and post-contrast T1 mapping images (mid-slice, short-axis, interventricular septum ROI) and hematocrit level as described in the literature (64), resulting elevated at 31%. The examination was performed with a 1.5 T scanner (Siemens Aera, Erlangen, Germany); in-center upper reference of normality for the sequence and vendor used are as follow: native T1 995 ms; native T2 49 ms, ECV 26%.