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

Objectives: To find simple imaging-based features on cardiac magnetic resonance (CMR) that are associated with major adverse cardiovascular events (MACE) in takotsubo syndrome (TTS).

Methods: Patients 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 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 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.

Results: Seventy-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 score (median [IQR], 2 [2-3] vs 1 [0-1]; p < 0.001). PERT score was associated with MACE on Cox regression analysis (hazard ratio per PERT feature, 2.44; 95%CI: 1.62-3.68; p < 0.001). Two or more PERT complications were strongly associated with the occurrence of MACE (log-rank p < 0.001).

Conclusions: The introduced PERT complication score might enable an easy-to-assess outcome evaluation of TTS patients by CMR.

Key Points: • Complications like pericardial effusion, pleural effusion, right ventricular involvement, and ventricular thrombus (summarised as PERT features) are relatively common in takotsubo syndrome. • The proposed PERT score (one point per complication) was associated with the occurrence of major adverse cardiac events on follow-up. • Complications easily detected by cardiac magnetic resonance imaging can help clinicians derive long-term prognostic information on patients with takotsubo syndrome.