Prognostische Relevanz Magnetresonanztomographie-Feature-Tracking-basierter myokardialer Mechanik bei Patienten mit Takotsubo-Kardiomyopathie

Prognostic relevance of cardiovascular magnetic resonance-feature-tracking derived myocardial mechanics in patients with Takotsubo cardiomyopathy

by Torben Lange
Doctoral thesis
Date of Examination:2020-01-08
Date of issue:2019-12-18
Advisor:Prof. Dr. Andreas Schuster
Referee:Prof. Dr. Andreas Schuster
Referee:Prof. Dr. Thomas Paul
Persistent Address: http://dx.doi.org/10.53846/goediss-7779

 

 

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Abstract

English

The aim of this work was to comprehensively assess the applicability as well as the diagnostic and prognostic value of cardiac magnetic resonance-feature-tracking (CMR-FT) derived cardiac mechanics in patients suffering Takotsubo cardiomyopathy (TTC). Image analyses were performed to generate various myocardial deformation parameters like left and right ventricular (LV and RV) strain and strain rate, LV torsion and dyssynchrony as well as atrial strain and strain rate parameters. Based on 152 prospectively enrolled TTC patients, myocardial contraction characteristics were documented and compared to controls and patients with myocardial infarction. Follow-up data regarding long-term survival were obtained. CMR follow-up was available in a subgroup. Deformation assessments enabled a precise quantification of LV dysfunction and allowed a discrimination of different TTC ballooning patterns. Strain parameters of TTC patients did not significantly differ from those of patients following ST-elevation myocardial infarction but allowed a differentiation against patients suffering non-ST-elevation myocardial infarction. Moreover, recovery of impaired deformation parameters of TTC patients in follow-up examinations was documented. LV global longitudinal strain was identified as a powerful parameter with high prognostic value for further risk stratification in TTC patients. During the acute phase of a TTC myocardial contraction was associated with higher dyssynchrony, that influenced myocardial rotational mechanics and was most pronounced in apical ballooning pattern. Atrial deformation analyses unveiled impaired strain values of reservoir and conduit function, that recovered during follow-up, whereas atrial booster pump function was increased, representing a potential compensation mechanism of impaired ventricular performance in TTC patients. Furthermore, both left atrial booster pump and reservoir function enabled a differentiation between high- and low-risk groups regarding long-term mortality. In conclusion, CMR-FT analyses assessing myocardial mechanics of TTC patients are feasible, clinically useful and carry prognostic implications. Future studies should apply these metrics and study their utility for optimized decision-making and potential to improve clinical outcome.
Keywords: CMR; Feature-Tracking; Myocardial strain; Takotsubo cardiomyopathy
 
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