Advanced cardiovascular magnetic resonance imaging in takotsubo syndrome: update on feature tracking and tissue mapping

Backgrounds: Takotsubo syndrome (TTS) is an intriguing clinical entity characterized by transient myocardial dysfunction. The precise pathophysiological mechanism of TTS is still unknown, but recent evidence suggests a central role of systemic inflammation associated with adrenergic discharge. Although initially considered benign, TTS has shown several potential short-term and long-term complications and adverse outcomes. To improve understanding and management, advanced cardiovascular magnetic resonance (CMR) techniques, such as feature tracking (FT) and parametric mapping, have gained attention. Purpose of Review: The purpose of this review is to summarize the current literature on the clinical applications of CMR-FT and mapping in TTS. Additionally, the most significant and recent findings will be discussed. Recent Findings: FT-CMR enables the parametric quantification of myocardial deformation, allowing a comprehensive evaluation of left ventricular, right ventricular, and atrial function. It provides an accurate definition of areas of myocardial dysfunction and potentially serves as a superior prognostic tool compared to ejection fraction. Tissue mapping techniques enable precise and comprehensive tissue characterization by quantifying areas of oedema, and myocardial fibrosis. Summary: FT-CMR and mapping techniques serve as valuable prognostic tools both in the acute and chronic phases of TTS. They can detect subtle alterations and pan-cardiac involvement, while also providing important insights into the complex underlying mechanisms of the syndrome.