Base-to-apex Gradient Pattern Assessed by Cardiovascular Magnetic Resonance in Takotsubo Cardiomyopathy

Riccardo Cau; Giuseppe Muscogiuri; Vitanio Palmisano; Michele Porcu; Alessandra Pintus; Roberta Montisci; Lorenzo Mannelli; Jasjit S Suri; Marco Francone; Luca Saba

doi:10.1097/RTI.0000000000000761

Base-to-apex Gradient Pattern Assessed by Cardiovascular Magnetic Resonance in Takotsubo Cardiomyopathy

J Thorac Imaging. 2023 Nov 1. doi: 10.1097/RTI.0000000000000761. Online ahead of print.

Authors

Affiliations

¹ Department of Radiology, Azienda Ospedaliero Universitaria, Monserrato, Cagliari, Italy.
² School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
³ Department of Radiology, IRCCS Istituto Auxologico Italiano, San Luca Hospital, Milan, Italy.
⁴ Ospedale General Regionale F. Miulli, Acquaviva delle Fonti, Italy.
⁵ Department of Cardiology, Azienda Ospedaliero Universitaria, Monserrato, Cagliari, Italy.
⁶ Department of Radiology, IRCCS SDN, Naples, Italy.
⁷ Stroke Diagnosis and Monitoring Division Atheropoint LLC, Roseville, CA.
⁸ Humanitas University, Pieve Emanuele, Italy.

PMID: 37905946
DOI: 10.1097/RTI.0000000000000761

Abstract

Objectives: The purpose of this study was to investigate the base-to-apex gradient strain pattern as a noncontrast cardiovascular magnetic resonance (CMR) parameter in patients with Takotsubo cardiomyopathy (TTC) and determine whether this pattern may help discriminate TTC from patients with anterior myocardial infarction (AMI).

Materials and methods: A total of 80 patients were included in the analysis: 30 patients with apical ballooning TTC and 50 patients with AMI. Global and regional ventricular function, including longitudinal (LS), circumferential (CS), and radial strain (RS), were assessed using CMR. The base-to-apex LS, RS, and CS gradients, defined as the peak gradient difference between averaged basal and apical strain, were calculated.

Results: The base-to-apex RS gradient was impaired in TTC patients compared with the AMI group (14.04 ± 15.50 vs. -0.43 ± 11.59, P=0.001). Conversely, there were no significant differences in the base-to-apex LS and CS gradients between the AMI group and TTC patients (0.14 ± 2.71 vs. -1.5 ± 3.69, P=0.054: -0.99 ± 6.49 vs. ±1.4 ± 5.43, P=0.47, respectively). Beyond the presence and extension of LGE, base-to-apex RS gradient was the only independent discriminator between TTC and AMI (OR 1.28; 95% CI 1.08, 1.52, P=0.006) in multivariate logistic regression analysis.

Conclusion: The findings of this study suggest that the pattern of regional myocardial strain impairment could serve as an additional noncontrast CMR tool to refine the diagnosis of TTC. A pronounced base-to-apex RS gradient may be a specific left ventricle strain pattern of TTC.