Atrial Impairment as a Marker in Discriminating Between Takotsubo and Acute Myocarditis Using Cardiac Magnetic Resonance

Purpose: The purpose of this study was to comprehensively compare the left and right atrium strain and strain rate (SR) parameters by cardiac magnetic resonance (CMR) between patients with Takotsubo (TS) and patients with acute myocarditis (AM). Materials and Methods: We retrospectively enrolled 3 groups of patients: TS (n=18), AM (n=14), and 11 healthy subjects. All the patients had complete CMR data for features tracking assessment. Differences in reservoir, conduit strain (epsilon(e)), conduit strain rate (SRe), and booster phase of biatrial strain were analyzed between the groups using analysis of variance and multivariate analysis of covariance analyses. Intraobserver and interobserver reproducibility was assessed for all strain and SR parameters using intraclass correlation coefficients and Bland-Altman analysis. Results: Atrial strain was feasible in all patients and controls. In TS, left atrium (LA) reservoir strain (epsilon(s)), reservoir SR, epsilon(e), and SRe were significantly lower compared with the other groups (P=0,001 for all). multivariate analysis of covariance analysis showed association of these parameters after correction for age and sex, while LA booster deformation (epsilon(a) and SRa) strain parameters were preserved. LA SRe proved to have excellent sensitivity in differentiating patients with TS from those with AM (areas under the curves of 0.903, 95% confidence interval: 0.81-0.99). Biatrial strain and SR parameters showed good (excellent) intraobserver and interobserver reproducibility (ranged between 0.61 to 0.96 and 0.50 to 0.90, respectively). Conclusion: Compared with AM, patients with TS showed significantly decreased LA reservoir, conduit strain, and SR parameters. Therefore, LA strain assessment may have a role in discriminating between TS and AM.

Automated summary

This study compared the strain and strain rate parameters of the left and right atrium in patients with Takotsubo and acute myocarditis by using cardiac magnetic resonance. The results showed that patients with Takotsubo had significantly decreased left atrium strain and strain rate parameters compared to patients with acute myocarditis. The assessment of left atrium strain may play a role in distinguishing between Takotsubo and acute myocarditis.