Atrial mechanics and their prognostic impact in Takotsubo syndrome: a cardiovascular magnetic resonance imaging study

Abstract Aims The exact pathophysiology of Takotsubo syndrome (TTS) remains not fully understood with most studies focussing on ventricular pathology. Since atrial involvement may have a significant role, we assessed the diagnostic and prognostic potential of atrial cardiovascular magnetic resonance...

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Published in:European heart journal cardiovascular imaging 2019-09, Vol.20 (9), p.1059-1069
Main Authors: Backhaus, Sören J, Stiermaier, Thomas, Lange, Torben, Chiribiri, Amedeo, Uhlig, Johannes, Freund, Anne, Kowallick, Johannes T, Gertz, Roman J, Bigalke, Boris, Villa, Adriana, Lotz, Joachim, Hasenfuß, Gerd, Thiele, Holger, Eitel, Ingo, Schuster, Andreas
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container_title European heart journal cardiovascular imaging
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creator Backhaus, Sören J
Stiermaier, Thomas
Lange, Torben
Chiribiri, Amedeo
Uhlig, Johannes
Freund, Anne
Kowallick, Johannes T
Gertz, Roman J
Bigalke, Boris
Villa, Adriana
Lotz, Joachim
Hasenfuß, Gerd
Thiele, Holger
Eitel, Ingo
Schuster, Andreas
description Abstract Aims The exact pathophysiology of Takotsubo syndrome (TTS) remains not fully understood with most studies focussing on ventricular pathology. Since atrial involvement may have a significant role, we assessed the diagnostic and prognostic potential of atrial cardiovascular magnetic resonance feature tracking (CMR-FT) in TTS. Methods and results This multicentre study recruited 152 TTS patients who underwent CMR on average within 3 days after hospitalization. Reservoir [total strain εs and peak positive strain rate (SR) SRs], conduit (passive strain εe and peak early negative SRe), and booster pump function (active strain εa and peak late negative SRa) were assessed in a core laboratory. Results were compared with 21 control patients with normal biventricular function. A total of 20 patients underwent follow-up CMR (median 3.5 months, interquartile range 3–5). All patients were approached for general follow-up. Left atrial (LA) but not right atrial (RA) reservoir and conduit function were impaired during the acute phase (εs: P = 0.043, εe: P 
doi_str_mv 10.1093/ehjci/jey219
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Since atrial involvement may have a significant role, we assessed the diagnostic and prognostic potential of atrial cardiovascular magnetic resonance feature tracking (CMR-FT) in TTS. Methods and results This multicentre study recruited 152 TTS patients who underwent CMR on average within 3 days after hospitalization. Reservoir [total strain εs and peak positive strain rate (SR) SRs], conduit (passive strain εe and peak early negative SRe), and booster pump function (active strain εa and peak late negative SRa) were assessed in a core laboratory. Results were compared with 21 control patients with normal biventricular function. A total of 20 patients underwent follow-up CMR (median 3.5 months, interquartile range 3–5). All patients were approached for general follow-up. Left atrial (LA) but not right atrial (RA) reservoir and conduit function were impaired during the acute phase (εs: P = 0.043, εe: P &lt; 0.001, SRe: P = 0.047 vs. controls) and recovered until follow-up (εs: P &lt; 0.001, SRs: P = 0.04, εe: P = 0.001, SRe: P = 0.04). LA and RA booster pump function were increased in the acute setting (LA-εa: P = 0.045, SRa: P = 0.002 and RA-εa: P = 0.004, SRa: P = 0.002 vs. controls). LA-εs predicted mortality [hazard ratio 1.10, 95% confidence interval (CI) 1.01–1.20; P = 0.037] irrespectively of established cardiovascular risk factors (P = 0.019, multivariate analysis) including left ventricular ejection fraction (LVEF) (area under the curve 0.71, 95% CI 0.55–0.86, P = 0.048). Conclusion TTS pathophysiology comprises transient impairments in LA reservoir and conduit functions and enhanced bi-atrial active booster pump functions. Atrial CMR-FT may evolve as a superior marker of adverse events over and above established parameters such as LVEF and atrial volume.</description><identifier>ISSN: 2047-2404</identifier><identifier>EISSN: 2047-2412</identifier><identifier>DOI: 10.1093/ehjci/jey219</identifier><identifier>PMID: 30649241</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><ispartof>European heart journal cardiovascular imaging, 2019-09, Vol.20 (9), p.1059-1069</ispartof><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com. 2019</rights><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c323t-570cc8b829fbfc97528acb435e41e67bd989d1bfae37b2aa9f0cccc89687cbc03</citedby><cites>FETCH-LOGICAL-c323t-570cc8b829fbfc97528acb435e41e67bd989d1bfae37b2aa9f0cccc89687cbc03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30649241$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Backhaus, Sören J</creatorcontrib><creatorcontrib>Stiermaier, Thomas</creatorcontrib><creatorcontrib>Lange, Torben</creatorcontrib><creatorcontrib>Chiribiri, Amedeo</creatorcontrib><creatorcontrib>Uhlig, Johannes</creatorcontrib><creatorcontrib>Freund, Anne</creatorcontrib><creatorcontrib>Kowallick, Johannes T</creatorcontrib><creatorcontrib>Gertz, Roman J</creatorcontrib><creatorcontrib>Bigalke, Boris</creatorcontrib><creatorcontrib>Villa, Adriana</creatorcontrib><creatorcontrib>Lotz, Joachim</creatorcontrib><creatorcontrib>Hasenfuß, Gerd</creatorcontrib><creatorcontrib>Thiele, Holger</creatorcontrib><creatorcontrib>Eitel, Ingo</creatorcontrib><creatorcontrib>Schuster, Andreas</creatorcontrib><title>Atrial mechanics and their prognostic impact in Takotsubo syndrome: a cardiovascular magnetic resonance imaging study</title><title>European heart journal cardiovascular imaging</title><addtitle>Eur Heart J Cardiovasc Imaging</addtitle><description>Abstract Aims The exact pathophysiology of Takotsubo syndrome (TTS) remains not fully understood with most studies focussing on ventricular pathology. Since atrial involvement may have a significant role, we assessed the diagnostic and prognostic potential of atrial cardiovascular magnetic resonance feature tracking (CMR-FT) in TTS. Methods and results This multicentre study recruited 152 TTS patients who underwent CMR on average within 3 days after hospitalization. Reservoir [total strain εs and peak positive strain rate (SR) SRs], conduit (passive strain εe and peak early negative SRe), and booster pump function (active strain εa and peak late negative SRa) were assessed in a core laboratory. Results were compared with 21 control patients with normal biventricular function. A total of 20 patients underwent follow-up CMR (median 3.5 months, interquartile range 3–5). All patients were approached for general follow-up. Left atrial (LA) but not right atrial (RA) reservoir and conduit function were impaired during the acute phase (εs: P = 0.043, εe: P &lt; 0.001, SRe: P = 0.047 vs. controls) and recovered until follow-up (εs: P &lt; 0.001, SRs: P = 0.04, εe: P = 0.001, SRe: P = 0.04). LA and RA booster pump function were increased in the acute setting (LA-εa: P = 0.045, SRa: P = 0.002 and RA-εa: P = 0.004, SRa: P = 0.002 vs. controls). LA-εs predicted mortality [hazard ratio 1.10, 95% confidence interval (CI) 1.01–1.20; P = 0.037] irrespectively of established cardiovascular risk factors (P = 0.019, multivariate analysis) including left ventricular ejection fraction (LVEF) (area under the curve 0.71, 95% CI 0.55–0.86, P = 0.048). Conclusion TTS pathophysiology comprises transient impairments in LA reservoir and conduit functions and enhanced bi-atrial active booster pump functions. Atrial CMR-FT may evolve as a superior marker of adverse events over and above established parameters such as LVEF and atrial volume.</description><issn>2047-2404</issn><issn>2047-2412</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNp9kD1PxDAMhiMEAgRszCgbDBwkae7asCHEl4TEAnPluO5djjY5khbp_j2BA0a82MPjR_bL2LEUF1KY4pIWS3SXS1orabbYvhK6nCgt1fbfLPQeO0ppKXJN9Uwrucv2CjHTJnP7bLweooOO94QL8A4TB9_wYUEu8lUMcx_S4JC7fgU4cOf5C7yFIY028LT2TQw9XXHgCLFx4QMSjh1E3sPc09depBQ8eKRsgLnzc56GsVkfsp0WukRHP_2Avd7dvtw8TJ6e7x9vrp8mWKhimExLgVjZSpnWtmjKqaoArS6mpCXNStuYyjTStkBFaRWAaTOfN8ysKtGiKA7Y2cabX3kfKQ117xJS14GnMKZaydIUVVVpldHzDYoxpBSprVcx3xzXtRT1V9b1d9b1JuuMn_yYR9tT8wf_JpuB0w0QxtX_qk_gF4xZ</recordid><startdate>20190901</startdate><enddate>20190901</enddate><creator>Backhaus, Sören J</creator><creator>Stiermaier, Thomas</creator><creator>Lange, Torben</creator><creator>Chiribiri, Amedeo</creator><creator>Uhlig, Johannes</creator><creator>Freund, Anne</creator><creator>Kowallick, Johannes T</creator><creator>Gertz, Roman J</creator><creator>Bigalke, Boris</creator><creator>Villa, Adriana</creator><creator>Lotz, Joachim</creator><creator>Hasenfuß, Gerd</creator><creator>Thiele, Holger</creator><creator>Eitel, Ingo</creator><creator>Schuster, Andreas</creator><general>Oxford University Press</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20190901</creationdate><title>Atrial mechanics and their prognostic impact in Takotsubo syndrome: a cardiovascular magnetic resonance imaging study</title><author>Backhaus, Sören J ; Stiermaier, Thomas ; Lange, Torben ; Chiribiri, Amedeo ; Uhlig, Johannes ; Freund, Anne ; Kowallick, Johannes T ; Gertz, Roman J ; Bigalke, Boris ; Villa, Adriana ; Lotz, Joachim ; Hasenfuß, Gerd ; Thiele, Holger ; Eitel, Ingo ; Schuster, Andreas</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c323t-570cc8b829fbfc97528acb435e41e67bd989d1bfae37b2aa9f0cccc89687cbc03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Backhaus, Sören J</creatorcontrib><creatorcontrib>Stiermaier, Thomas</creatorcontrib><creatorcontrib>Lange, Torben</creatorcontrib><creatorcontrib>Chiribiri, Amedeo</creatorcontrib><creatorcontrib>Uhlig, Johannes</creatorcontrib><creatorcontrib>Freund, Anne</creatorcontrib><creatorcontrib>Kowallick, Johannes T</creatorcontrib><creatorcontrib>Gertz, Roman J</creatorcontrib><creatorcontrib>Bigalke, Boris</creatorcontrib><creatorcontrib>Villa, Adriana</creatorcontrib><creatorcontrib>Lotz, Joachim</creatorcontrib><creatorcontrib>Hasenfuß, Gerd</creatorcontrib><creatorcontrib>Thiele, Holger</creatorcontrib><creatorcontrib>Eitel, Ingo</creatorcontrib><creatorcontrib>Schuster, Andreas</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European heart journal cardiovascular imaging</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Backhaus, Sören J</au><au>Stiermaier, Thomas</au><au>Lange, Torben</au><au>Chiribiri, Amedeo</au><au>Uhlig, Johannes</au><au>Freund, Anne</au><au>Kowallick, Johannes T</au><au>Gertz, Roman J</au><au>Bigalke, Boris</au><au>Villa, Adriana</au><au>Lotz, Joachim</au><au>Hasenfuß, Gerd</au><au>Thiele, Holger</au><au>Eitel, Ingo</au><au>Schuster, Andreas</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Atrial mechanics and their prognostic impact in Takotsubo syndrome: a cardiovascular magnetic resonance imaging study</atitle><jtitle>European heart journal cardiovascular imaging</jtitle><addtitle>Eur Heart J Cardiovasc Imaging</addtitle><date>2019-09-01</date><risdate>2019</risdate><volume>20</volume><issue>9</issue><spage>1059</spage><epage>1069</epage><pages>1059-1069</pages><issn>2047-2404</issn><eissn>2047-2412</eissn><abstract>Abstract Aims The exact pathophysiology of Takotsubo syndrome (TTS) remains not fully understood with most studies focussing on ventricular pathology. Since atrial involvement may have a significant role, we assessed the diagnostic and prognostic potential of atrial cardiovascular magnetic resonance feature tracking (CMR-FT) in TTS. Methods and results This multicentre study recruited 152 TTS patients who underwent CMR on average within 3 days after hospitalization. Reservoir [total strain εs and peak positive strain rate (SR) SRs], conduit (passive strain εe and peak early negative SRe), and booster pump function (active strain εa and peak late negative SRa) were assessed in a core laboratory. Results were compared with 21 control patients with normal biventricular function. A total of 20 patients underwent follow-up CMR (median 3.5 months, interquartile range 3–5). All patients were approached for general follow-up. Left atrial (LA) but not right atrial (RA) reservoir and conduit function were impaired during the acute phase (εs: P = 0.043, εe: P &lt; 0.001, SRe: P = 0.047 vs. controls) and recovered until follow-up (εs: P &lt; 0.001, SRs: P = 0.04, εe: P = 0.001, SRe: P = 0.04). LA and RA booster pump function were increased in the acute setting (LA-εa: P = 0.045, SRa: P = 0.002 and RA-εa: P = 0.004, SRa: P = 0.002 vs. controls). LA-εs predicted mortality [hazard ratio 1.10, 95% confidence interval (CI) 1.01–1.20; P = 0.037] irrespectively of established cardiovascular risk factors (P = 0.019, multivariate analysis) including left ventricular ejection fraction (LVEF) (area under the curve 0.71, 95% CI 0.55–0.86, P = 0.048). Conclusion TTS pathophysiology comprises transient impairments in LA reservoir and conduit functions and enhanced bi-atrial active booster pump functions. Atrial CMR-FT may evolve as a superior marker of adverse events over and above established parameters such as LVEF and atrial volume.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>30649241</pmid><doi>10.1093/ehjci/jey219</doi><tpages>11</tpages></addata></record>
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title Atrial mechanics and their prognostic impact in Takotsubo syndrome: a cardiovascular magnetic resonance imaging study
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