背景:我们调查了亚急性和恢复期塔克替诺综合征(TTS)左心室(LV)和左心房(LA)收缩功能障碍受损的差异,使用心脏磁共振(CMR)特征跟踪技术进行心肌应变分析。
方法:我们回顾性选择了50例TTS临床放射学诊断的患者,这些患者在症状发作后30天内接受了CMR:在亚急性期早期研究了19例(sTTS,≤7天)和31在恢复期(cTTS,8-30天)。我们测量了以下内容:LV全局纵向,圆周,和径向应变(lvGLS,lvGCS,lvGRS)和应变率(SR)和LA储层(laS_r),导管(laS_cd),和增压泵应变(laS_bp)和应变率(laSR_r,laSR_cd,laSR_bp)。将患者与30名年龄和性别匹配的对照进行比较。
结果:所有患者均为女性(平均年龄63岁)。TTS患者表现出改变的LV和LA应变特征,与对照组相比。sTTS与增加的laS_bp(12.7%对9.8%)和降低的lvEF(47.4%对54.8%)相关,lvGLS(-12.2%对14.6%),和laS_cd(7.0%对9.5%)与cTTS(p≤0.029)相比。症状发作和CMR之间的间隔与laS_bp(r=-0.49)和lvGLS(r=0.47)(两者的p=0.001)相关。在接收机工作特性分析中,laS_bp是sTTS和cTTS的最佳鉴别器(曲线下面积[AUC]0.815),其次是lvGLS(AUC0.670)。
结论:LA功能障碍在TTS的亚急性和恢复期持续存在。laS_bp在亚急性期增加,恢复期逐渐减少,代表LV功能障碍的代偿机制,因此是功能恢复的有用指标。
结论:心房菌株有可能增强TTS患者心脏损伤和功能损害的描述,协助识别风险较高的个人,并促进实施更有针对性和个性化的医疗治疗。
结论:•在TTS中,心室恢复后,通过CMR特征追踪可评估心房功能障碍持续存在.•心房应变的定量评估可区分心房功能:储层,导管,和增压泵。•急性TTS后心房增压泵的变化,不管心室功能。•心房菌株可用作TTS中的时间标记。
BACKGROUND: We investigated the differences in impairment of left ventricle (LV) and left atrium (LA) contractile dysfunction between subacute and convalescent takotsubo syndrome (TTS), using myocardial strain analysis by cardiac magnetic resonance (CMR) feature-tracking technique.
METHODS: We retrospectively selected 50 patients with TTS clinical-radiological diagnosis who underwent CMR within 30 days since symptoms onset: 19 studied during the early subacute phase (sTTS, ≤ 7 days) and 31 during the convalescence (cTTS, 8-30 days). We measured the following: LV global longitudinal, circumferential, and radial strain (lvGLS, lvGCS, lvGRS) and strain rate (SR) and LA reservoir (laS_r), conduit (laS_cd), and booster pump strain (laS_bp) and strain rate (laSR_r, laSR_cd, laSR_bp). Patients were compared with 30 age- and sex-matched controls.
RESULTS: All patients were women (mean age 63 years). TTS patients showed altered LV- and LA-strain features, compared to controls. sTTS was associated with increased laS_bp (12.7% versus 9.8%) and reduced lvEF (47.4% versus 54.8%), lvGLS (-12.2% versus 14.6%), and laS_cd (7.0% versus 9.5%) compared to cTTS (p ≤ 0.029). The interval between symptoms onset and CMR was correlated with laS_bp (r = -0.49) and lvGLS (r = 0.47) (p = 0.001 for both). At receiver operating characteristics analysis, laS_bp was the best discriminator between sTTS and cTTS (area under the curve [AUC] 0.815), followed by lvGLS (AUC 0.670).
CONCLUSIONS: LA dysfunction persists during the subacute and convalescence of TTS. laS_bp increases in subacute phase with progressive decrease during convalescence, representing a compensatory mechanism of LV dysfunction and thus a useful index of functional recovery.
CONCLUSIONS: Atrial strain has the potential to enhance the delineation of cardiac injury and functional impairment in TTS patients, assisting in the identification of individuals at higher risk and facilitating the implementation of more targeted and personalized medical therapies.
CONCLUSIONS: • In TTS, after ventricular recovery, atrial dysfunction persists assessable with CMR feature tracking. • Quantitative assessment of atrial strain discriminates atrial functions: reservoir, conduit, and booster pump. • Atrial booster pump changes after acute TTS, regardless of ventricular function. • Atrial strain may serve as a temporal marker in TTS.