SPC365

TEMPORAL CHARACTERIZATION OF VENTRICULAR FUNCTION AND DEFORMATION AFTER TAKOTSUBO SYNDROME USING CARDIOVASCULAR MAGENTIC RESONANCE IMAGING

Session: CO 20 - Imagem na IC e Doença Coronária
Speaker: Carla Marques Pires

Congress: CPC 2021
Topic: B. Imaging
Theme: 03. Imaging
Subtheme: 03.3 Cardiac Magnetic Resonance
Session Type: Comunicações Orais
FP Number: ---
Authors: Carla Marques Pires; Rita Morais Passos; Paulo Medeiros; Cátia Oliveira; Rui Flores; Fernando Mané; Rodrigo Silva; Isabel Campos; Nuno Antunes; Catarina Vieira; Sandro Queirós; Vitor Hugo Pereira

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>INTRODUCTION</strong>:</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The time course of ventricular recovery in Takotsubo Syndrome (TS) patients(pts) is still not well characterized. Quantification of myocardial deformation using Cardiovascular Magnetic Resonance Feature-Tracking (CMR-FT) may be a useful method to better characterize ventricular recovery during TS.</span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>AIM:</strong> </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">To assess the time course of ventricular function using CMR-FT myocardial strain in patients (pts) with an episode of TS.</span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>METHODS:</strong> </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">We performed a single-center, retrospective cohort study including 130 pts admitted with TS over a 10-year period. From this cohort, 39 (30%) pts were selected and age and sex-matched with 16 healthy controls for a comparative analysis of myocardial strain using CMR-FT. TS pts were divided in 3 homogeneous subgroups according to the time from index-event and the CMR acquisition: Group 1(G1): &lt;8 days; Group 2(G2): 8 to 30 days; Group 3 (G3): &gt;30 days.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">One operator blinded for the study group performed the analysis. Left ventricle (LV) radial strain (RS), longitudinal strain (LS) and right ventricle (RV) LS were quantified. </span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>RESULTS:</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The mean age of TS group was 66 years and 90% were female. The median ejection fraction (EF) at admission was 38%; 82% displayed an apical ballooning (AB) pattern. Around 19% had at least 1 in-hospital complication and 1.5% died during hospitalization. A significant increase use of CMR was observed over the years (p=0.001). </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Myocardial deformation analysis showed a significant group interaction for LV LS and RS. Specifically, the global values of G1 LV LS and RS were significantly decreased when compared with G3 (LS:-15vs-20%;p=0.002; RS:40vs61%; p&lt;0.001) and controls (LS:-15vs-22%;p&lt;0.001; RS: 40vs70; p&lt;0.001). There were no significant differences in the RV LS across groups. </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The CMR-quantified EF was significantly decreased in G1 when compared with G3 (52vs64%; p&lt;0.003) and controls (52vs64%; p&lt;0.001). Differences between G1 and G2 were found in LV RS (LS:40vs57%; p&lt;0.001) and EF (52vs62%; p&lt;0.001). No differences were observed for any parameters between G3 and controls. </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">This study showed that global LV LS (r=-0.6, p&lt;0.001) and RS (r=0.7, p&lt;0.001) had a significant correlation with the CMR-quantified EF.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">A comparison between the different patterns of TS was also performed <em>(Figure 1)</em>. Pts with AB pattern in G1 displayed lower global RS (P=0.014), although there were no differences regarding global LS. As expected, in the AB group the reduction in myocardial strain was limited to the apical segments. </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Despite not being significantly different across groups RV LS was the only CMR-derived predictor of complications during follow-up (OR=1.17; p=0.026).</span></span></p>

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<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>CONCLUSION:</strong></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">This study revealed that after an episode of TS myocardial function quantified either by EF or CMR-FT strain fully recovers between the 8<sup>th</sup> and 30<sup>th</sup> day of the event. RV strain was a predictor of complications during follow-up.</span></span></p>

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