Heart failure & cardiomyopathiesCohort study
CMR Reveals the Influence of Trigger and Classification on the Myocardial Tissue Response in Takotsubo Syndrome
- multicenter cohort study
Authors' conclusion
TTS due to emotional stress is associated with larger myocardial edema, and secondary TTS exhibited late gadolinium enhancement more frequently, indicative of direct myocardial damage. These findings suggest that emotionally primed heart dysfunction and direct myocardial injury contribute to TTS pathophysiology to varying extents, influenced by both the triggering factor and preexisting conditions.
Study context
- Population
- Patients with Takotsubo syndrome (TTS) from the InterTAK registry who received cardiovascular magnetic resonance 3 (interquartile range, 2–5) days after symptom onset95% women, age 66±12 years
- Participants
- 110 patients
- Exposure
- across the InterTAK classification and between primary and secondary TTS
Main finding
As reported in the abstract
- No significant differences across the 3 InterTAK groups or between primary and secondary TTS
Observational data: associations, not effects.
Further findings
| Outcome | Emotional triggers | Physical triggers | Primary TTS | Secondary TTS | P value |
|---|---|---|---|---|---|
| Myocardial edema · larger with emotional triggers | 72% | 60% | Not reported in the abstract | Not reported in the abstract | P < 0.01 |
| Focal or patchy late gadolinium enhancement · higher prevalence with secondary TTS | Not reported in the abstract | Not reported in the abstract | 19% | 54% | P < 0.01 |
Myocardial edema
- Higher T2-mapping values in a subset of 22 patients with T2-mapping
Independent associations with extent of myocardial edema (multivariable regression)
- emotional trigger
- P < 0.01
- absence of coronary artery disease
- P = 0.04
Presence of any late gadolinium enhancement (multivariable logistic regression)
- secondary TTS
- P < 0.01
- early cardiovascular magnetic resonance
- P = 0.02
Original publication
Summarised from the published abstract; every number is checked against it