A novel and simple cardiac magnetic resonance score (PE2RT) predicts outcome in takotsubo syndrome

ObjectivesTo find simple imaging-based features on cardiac magnetic resonance (CMR) that are associated with major adverse cardiovascular events (MACE) in takotsubo syndrome (TTS).MethodsPatients with TTS referred for CMR between 2007 and 2021 were retrospectively evaluated. Besides standard CMR analysis, commonly known complications of TTS based on expert knowledge were assessed and summarised via a newly developed (PERT)-R-2 score (one point each for pleural effusion, pericardial effusion, right ventricular involvement, and ventricular thrombus). Clinical follow-up data was reviewed up to three years after discharge. The relationship between (PERT)-R-2 features and the occurrence of MACE (cardiovascular death or new hospitalisation due to acute myocardial injury, arrhythmia, or chronic heart failure) was examined using Cox regression analysis and Kaplan-Meier estimator.ResultsSeventy-nine patients (mean age, 68 +/- 14 years; 72 women) with TTS were included. CMR was performed in a median of 4 days (IQR, 2-6) after symptom onset. Over a median follow-up of 13.3 months (IQR, 0.4-36.0), MACE occurred in 14/79 (18%) patients: re-hospitalisation due to acute symptoms (9/79, 11%) or chronic heart failure symptoms (4/79, 5%), and cardiac death (1/79, 1%). Patients with MACE had a higher (PERT)-R-2 score (median [IQR], 2 [2-3] vs 1 [0-1]; p < 0.001). (PERT)-R-2 score was associated with MACE on Cox regression analysis (hazard ratio per (PERT)-R-2 feature, 2.44; 95%CI: 1.62-3.68; p < 0.001). Two or more (PERT)-R-2 complications were strongly associated with the occurrence of MACE (log-rank p < 0.001).ConclusionsThe introduced (PERT)-R-2 complication score might enable an easy-to-assess outcome evaluation of TTS patients by CMR.

Automated summary

Simple imaging-based features on cardiac magnetic resonance (CMR) can be used to predict major adverse cardiovascular events (MACE) in patients with takotsubo syndrome (TTS). A newly developed (PERT)-R-2 score was found to be associated with MACE in TTS patients. Higher score was associated with increased risk of MACE, and the presence of two or more (PERT)-R-2 complications was strongly associated with MACE occurrence.