Prognostic value of cardiac magnetic resonance global T2 mapping in patients with takotsubo syndrome
Abstract
Aims: Myocardial oedema is a hallmark of takotsubo syndrome (TTS). Cardiac magnetic resonance (CMR) T2 mapping quantifies myocardial oedema, but its prognostic value in TTS is unclear. We evaluated the association between CMR-derived global myocardial T2 and major adverse cardiovascular and cerebrovascular events (MACE).
Methods and results: We retrospectively identified consecutive TTS patients undergoing CMR with tissue mapping within 30 days of admission. Imaging was re-analysed, blinded to clinical data. The primary endpoint was MACE (all-cause death, heart failure hospitalization, recurrent TTS, stroke, or transient ischaemic attack). Time-dependent receiver operating characteristic (ROC) analysis derived a T2 threshold. Prespecified covariates were summarized by ridge-penalized Cox into a single linear predictor for adjustment. A Firth-penalized Cox model tested robustness. Among 110 patients (median age 68 years; 91% women), median global T2 was 56 ms (IQR 53–60), and 17 (15.5%) experienced MACE over a median follow-up of 763 days (IQR 525–1357). T2 ≥ 63 ms predicted 1-year MACE (AUC 0.671, sensitivity 56%, specificity 89%) and separated Kaplan–Meier curves (log-rank P = 0.003). In ridge-penalized Cox models, each 5 ms increase in global T2 was associated with MACE (HR 1.40, 95% CI 1.06–1.87; P = 0.020). This association was also observed after adjustment in the Firth-penalized model (HR 1.70, 95% CI 1.20–2.40; P = 0.004). An internally derived threshold of T2 ≥ 63 ms was also associated with MACE but showed modest 1-year discrimination (AUC 0.671).
Conclusion: Global myocardial T2 may provide incremental prognostic information beyond prespecified clinical and imaging indices in TTS and refine risk stratification.
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BibTeX
@article{kadoya2026prognostic,
title = {{Prognostic value of cardiac magnetic resonance global T2 mapping in patients with takotsubo syndrome}},
author = {Yoshito Kadoya and Jerald Lim and Mohammed Alaqaili and Jamilah Mohammed Al-Harbi and Pape-Mamadou Sene and Mohammed El Mehdi El Yamani and Rebecca E Thornhill and Andrew M Crean and D Ian Paterson},
journal = {European Heart Journal Cardiovascular Imaging},
year = {2026},
month = sep,
doi = {10.1093/ehjci/jeag243},
url = {https://doi.org/10.1093/ehjci/jeag243},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Prognostic value of cardiac magnetic resonance global T2 mapping in patients with takotsubo syndrome
AU - Yoshito Kadoya
AU - Jerald Lim
AU - Mohammed Alaqaili
AU - Jamilah Mohammed Al-Harbi
AU - Pape-Mamadou Sene
AU - Mohammed El Mehdi El Yamani
AU - Rebecca E Thornhill
AU - Andrew M Crean
AU - D Ian Paterson
PY - 2026
DA - 2026/09/07
JO - European Heart Journal Cardiovascular Imaging
DO - 10.1093/ehjci/jeag243
UR - https://doi.org/10.1093/ehjci/jeag243
AB - Aims: Myocardial oedema is a hallmark of takotsubo syndrome (TTS). Cardiac magnetic resonance (CMR) T2 mapping quantifies myocardial oedema, but its prognostic value in TTS is unclear. We evaluated the association between CMR-derived global myocardial T2 and major adverse cardiovascular and cerebrovascular events (MACE). Methods and results: We retrospectively identified consecutive TTS patients undergoing CMR with tissue mapping within 30 days of admission. Imaging was re-analysed, blinded to clinical data. The primary endpoint was MACE (all-cause death, heart failure hospitalization, recurrent TTS, stroke, or transient ischaemic attack). Time-dependent receiver operating characteristic (ROC) analysis derived a T2 threshold. Prespecified covariates were summarized by ridge-penalized Cox into a single linear predictor for adjustment. A Firth-penalized Cox model tested robustness. Among 110 patients (median age 68 years; 91% women), median global T2 was 56 ms (IQR 53–60), and 17 (15.5%) experienced MACE over a median follow-up of 763 days (IQR 525–1357). T2 ≥ 63 ms predicted 1-year MACE (AUC 0.671, sensitivity 56%, specificity 89%) and separated Kaplan–Meier curves (log-rank P = 0.003). In ridge-penalized Cox models, each 5 ms increase in global T2 was associated with MACE (HR 1.40, 95% CI 1.06–1.87; P = 0.020). This association was also observed after adjustment in the Firth-penalized model (HR 1.70, 95% CI 1.20–2.40; P = 0.004). An internally derived threshold of T2 ≥ 63 ms was also associated with MACE but showed modest 1-year discrimination (AUC 0.671). Conclusion: Global myocardial T2 may provide incremental prognostic information beyond prespecified clinical and imaging indices in TTS and refine risk stratification.
SN - 2047-2404
SN - 2047-2412
ER -