{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T01:46:21Z","timestamp":1789695981422,"version":"4.0.1"},"reference-count":43,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2023,3,2]],"date-time":"2023-03-02T00:00:00Z","timestamp":1677715200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,7,24]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>myocardial oedema is largely represented in takotsubo syndrome (TTS) and may contribute to alter the myocardium morphology and function. The aim of the study is to describe relationships between oedema, mechanical, and electrical abnormalities in TTS<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>the study included n = 32 hospitalized TTS patients and n = 23 controls. Cardiac magnetic resonance (CMR) with tissue mapping and feature tracking was performed with concomitant 12-lead electrocardiogram (ECG) recording. Mean age of TTS was 72 \u00b1 12 years old, 94% women. Compared with controls, patients had higher left ventricular (LV) mass, worse systolic function, higher septal native T1 (1116 \u00b1 73 msec vs. 970 \u00b1 23 msec, P &amp;lt; 0.001), T2 (56 \u00b1 5 msec vs. 46 \u00b1 2 msec, P &amp;lt; 0.001), and extracellular volume (ECV) fraction (32 \u00b1 5% vs. 24 \u00b1 1%, P &amp;lt; 0.001). TTS patients had higher apicobasal gradient of T2 values (12 \u00b1 6 msec vs. 2 \u00b1 6 msec, P &amp;lt; 0.001); basal LV wall displayed higher native T1, T2, and ECV (all P &amp;lt; 0.002) but similar circumferential strain against controls (\u221223 \u00b1 3% vs. \u221224 \u00b1 4%, P = 0.351). In the TTS cohort, septal T2 values showed significant correlations with native T1 (r = 0.609, P &amp;lt; 0.001), ECV (r = 0.689, P &amp;lt; 0.001), left ventricular ejection fraction (r = \u22120.459, P = 0.008) and aVR voltage (r = \u22120.478, P = 0.009). Negative T-wave voltage and QTc length correlated with apicobasal T2 mapping gradient (r = 0.499, P = 0.007 and r = 0.372, P = 0.047, respectively) but not with other tissue mapping measurements.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>CMR T1 and T2 mapping demonstrated increased myocardial water content conditioning interstitial expansion in acute TTS, detected even outside areas of abnormal wall motion. Oedema burden and distribution associated with mechanical and electrocardiographic changes, making it a potential prognostic marker and therapeutic target in TTS.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjci\/jead035","type":"journal-article","created":{"date-parts":[[2023,3,2]],"date-time":"2023-03-02T14:31:00Z","timestamp":1677767460000},"page":"1082-1091","source":"Crossref","is-referenced-by-count":29,"title":["Myocardial oedema contributes to interstitial expansion and associates with mechanical and electrocardiographic changes in takotsubo syndrome: a CMR T1 and T2 mapping study"],"prefix":"10.1093","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1410-6845","authenticated-orcid":false,"given":"Luca","family":"Arcari","sequence":"first","affiliation":[{"name":"Cardiology Unit, Madre Giuseppina Vannini Hospital , Via di Acqua Bullicante 4, 00177 Rome , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4865-0454","authenticated-orcid":false,"given":"Giovanni","family":"Camastra","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Madre Giuseppina Vannini Hospital , Via di Acqua Bullicante 4, 00177 Rome , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Ciolina","sequence":"additional","affiliation":[{"name":"Radiology Unit, Madre Giuseppina Vannini Hospital , Via di Acqua Bullicante 4, 00177 Rome , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca Rosario","family":"Limite","sequence":"additional","affiliation":[{"name":"Service de Cardiologie, Hopital Priv\u00e9e Les Franciscaines ELSAN , 3 Rue Jean Bouin, 30000 N\u00eemes , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimiliano","family":"Danti","sequence":"additional","affiliation":[{"name":"Radiology Unit, Madre Giuseppina Vannini Hospital , Via di Acqua Bullicante 4, 00177 Rome , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Sclafani","sequence":"additional","affiliation":[{"name":"Cardiology, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome , Via di Grottarossa 1035, 00189 Rome , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerardo","family":"Ansalone","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Madre Giuseppina Vannini Hospital , Via di Acqua Bullicante 4, 00177 Rome , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Beatrice","family":"Musumeci","sequence":"additional","affiliation":[{"name":"Cardiology, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome , Via di Grottarossa 1035, 00189 Rome , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6044-950X","authenticated-orcid":false,"given":"Eike","family":"Nagel","sequence":"additional","affiliation":[{"name":"Medical Faculty of Goethe University, Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt , Theodor-Stern-Kai 7 , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Puntmann","sequence":"additional","affiliation":[{"name":"Medical Faculty of Goethe University, Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt , Theodor-Stern-Kai 7 , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Sbarbati","sequence":"additional","affiliation":[{"name":"Radiology Unit, Madre Giuseppina Vannini Hospital , Via di Acqua Bullicante 4, 00177 Rome , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Cacciotti","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Madre Giuseppina Vannini Hospital , Via di Acqua Bullicante 4, 00177 Rome , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,3,2]]},"reference":[{"key":"2023072413345683500_jead035-B1","article-title":"Stress cardiomyopathy diagnosis and treatment: JACC state-of-the-art review","volume":"72","author":"Medina de Chazal","journal-title":"J Am Coll Cardiol"},{"key":"2023072413345683500_jead035-B2","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1002\/ejhf.2400","article-title":"Pathophysiology of takotsubo syndrome\u2014a joint scientific statement from the heart failure association takotsubo syndrome study group and myocardial function working group of the European society of cardiology\u2014part 1: overview and the central role for catecholamines and sympathetic nervous system","volume":"24","author":"Omerovic","year":"2022","journal-title":"Eur J Heart Fail"},{"key":"2023072413345683500_jead035-B3","first-page":"277","article-title":"Clinical characteristics and cardiovascular magnetic resonance findings in stress (takotsubo) cardiomyopathy","volume":"306","author":"Eitel","year":"2011","journal-title":"JAMA"},{"key":"2023072413345683500_jead035-B4","doi-asserted-by":"crossref","first-page":"1581","DOI":"10.1161\/CIRCULATIONAHA.118.037975","article-title":"Myocardial and systemic inflammation in acute stress-induced (takotsubo) cardiomyopathy","volume":"139","author":"Scally","year":"2019","journal-title":"Circulation"},{"key":"2023072413345683500_jead035-B5","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.atherosclerosis.2018.05.017","article-title":"Inflammatory patterns in takotsubo cardiomyopathy and acute coronary syndrome: A propensity score matched analysis","volume":"274","author":"Santoro","year":"2018","journal-title":"Atherosclerosis"},{"key":"2023072413345683500_jead035-B6","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1161\/CIRCRESAHA.116.307974","article-title":"T1 mapping in characterizing myocardial disease","volume":"119","author":"Puntmann","year":"2016","journal-title":"Circ Res"},{"key":"2023072413345683500_jead035-B7","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1186\/1532-429X-11-56","article-title":"T2 quantification for improved detection of myocardial edema","volume":"11","author":"Giri","year":"2009","journal-title":"J Cardiovasc Magn Reson"},{"key":"2023072413345683500_jead035-B8","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1161\/CIRCIMAGING.111.967836","article-title":"Improved detection of myocardial involvement in acute inflammatory cardiomyopathies using T2 mapping","volume":"5","author":"Thavendiranathan","year":"2012","journal-title":"Circ Cardiovasc Imaging"},{"key":"2023072413345683500_jead035-B9","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.1093\/ehjci\/jez034","article-title":"Clinical impact of native T1 mapping for detecting myocardial impairment in takotsubo cardiomyopathy","volume":"20","author":"Aikawa","year":"2019","journal-title":"Eur Hear J Cardiovasc Imaging"},{"key":"2023072413345683500_jead035-B10","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.ijcard.2020.03.039","article-title":"Cardiac magnetic resonance for assessment of cardiac involvement in takotsubo syndrome: do we still need contrast administration?","volume":"308","author":"Vermes","year":"2020","journal-title":"Int J Cardiol"},{"key":"2023072413345683500_jead035-B11","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1161\/CIRCULATIONAHA.117.031841","article-title":"Persistent long-term structural, functional, and metabolic changes after stress-induced (takotsubo) cardiomyopathy","volume":"137","author":"Scally","year":"2018","journal-title":"Circulation"},{"key":"2023072413345683500_jead035-B12","doi-asserted-by":"crossref","first-page":"948","DOI":"10.3389\/fcvm.2021.703418","article-title":"Novel imaging and genetic risk markers in takotsubo syndrome","volume":"8","author":"Arcari","year":"2021","journal-title":"Front Cardiovasc Med"},{"key":"2023072413345683500_jead035-B13","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/j.ejrad.2019.02.026","article-title":"Cardiac magnetic resonance including parametric mapping in acute takotsubo syndrome: preliminary findings","volume":"113","author":"Dabir","year":"2019","journal-title":"Eur J Radiol"},{"key":"2023072413345683500_jead035-B14","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1186\/s12968-016-0269-7","article-title":"Principles of cardiovascular magnetic resonance feature tracking and echocardiographic speckle tracking for informed clinical use","volume":"18","author":"Pedrizzetti","year":"2016","journal-title":"J Cardiovasc Magn Reson"},{"key":"2023072413345683500_jead035-B15","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.hrthm.2012.09.004","article-title":"Apicobasal gradient of left ventricular myocardial edema underlies transient T-wave inversion and QT interval prolongation (wellens\u2019 ECG pattern) in tako-tsubo cardiomyopathy","volume":"10","author":"Perazzolo Marra","year":"2013","journal-title":"Hear Rhythm"},{"key":"2023072413345683500_jead035-B16","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1177\/2048872613504311","article-title":"Transient attenuation of the amplitude of the QRS complexes in the diagnosis of takotsubo syndrome","volume":"3","author":"Madias","year":"2014","journal-title":"Eur Hear J Acute Cardiovasc Care"},{"key":"2023072413345683500_jead035-B17","doi-asserted-by":"crossref","DOI":"10.3390\/jcm11040987","article-title":"Dynamic trend of myocardial edema in takotsubo syndrome: A serial cardiac magnetic resonance study","volume":"11","author":"Kato","year":"2022","journal-title":"J Clin Med"},{"key":"2023072413345683500_jead035-B18","doi-asserted-by":"crossref","first-page":"2085","DOI":"10.1016\/j.jacc.2022.03.366","article-title":"Gender differences in takotsubo syndrome","volume":"79","author":"Arcari","year":"2022","journal-title":"J Am Coll Cardiol"},{"key":"2023072413345683500_jead035-B19","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1056\/NEJMoa1406761","article-title":"Clinical features and outcomes of takotsubo (stress) cardiomyopathy","volume":"373","author":"Templin","year":"2015","journal-title":"N Engl J Med"},{"key":"2023072413345683500_jead035-B20","doi-asserted-by":"crossref","DOI":"10.1016\/j.ijcard.2018.07.145","article-title":"Admission heart rate and in-hospital course of patients with takotsubo syndrome","volume":"273","author":"Arcari","year":"2018","journal-title":"Int J Cardiol"},{"key":"2023072413345683500_jead035-B21","doi-asserted-by":"crossref","first-page":"e001165","DOI":"10.1136\/bmjopen-2012-001165","article-title":"Observational study on takotsubo-like cardiomyopathy: clinical features, diagnosis, prognosis and follow-up","volume":"2","author":"Cacciotti","year":"2012","journal-title":"BMJ Open"},{"key":"2023072413345683500_jead035-B22","doi-asserted-by":"crossref","first-page":"597","DOI":"10.31083\/j.rcm2203071","article-title":"Long-term management of takotsubo syndrome: a not-so-benign condition","volume":"22","author":"Sclafani","year":"2021","journal-title":"Rev Cardiovasc Med"},{"key":"2023072413345683500_jead035-B23","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1111\/j.1540-8175.2010.01152.x","article-title":"Relationship between giant negative T-wave and severity of apical hypertrophy in patients with apical hypertrophic cardiomyopathy","volume":"27","author":"Park","year":"2010","journal-title":"Echocardiography"},{"key":"2023072413345683500_jead035-B24","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1016\/j.jjcc.2017.01.006","article-title":"QT Spatial dispersion and sudden cardiac death in hypertrophic cardiomyopathy: time for reappraisal","volume":"70","author":"Magr\u00ec","year":"2017","journal-title":"J Cardiol"},{"key":"2023072413345683500_jead035-B25","doi-asserted-by":"crossref","first-page":"1567","DOI":"10.1111\/j.1540-8159.2009.02568.x","article-title":"aVR, an index of all ECG limb leads, with clinical utility for monitoring of patients with edematous states, including heart failure","volume":"32","author":"Madias","year":"2009","journal-title":"Pacing Clin Electrophysiol"},{"key":"2023072413345683500_jead035-B26","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12968-017-0389-8","article-title":"Clinical recommendations for cardiovascular magnetic resonance mapping of T1, T2, T2* and extracellular volume: a consensus statement by the society for cardiovascular magnetic resonance (SCMR) endorsed by the European association for cardiovascular imaging (EACVI)","volume":"19","author":"Messroghli","year":"2017","journal-title":"J Cardiovasc Magn Reson"},{"key":"2023072413345683500_jead035-B27","doi-asserted-by":"crossref","DOI":"10.1186\/s12968-018-0484-5","article-title":"Society for cardiovascular magnetic resonance (SCMR) expert consensus for CMR imaging endpoints in clinical research: part i\u2014analytical validation and clinical qualification","volume":"20","author":"Puntmann","year":"2018","journal-title":"J Cardiovasc Magn Reson"},{"key":"2023072413345683500_jead035-B28","doi-asserted-by":"crossref","first-page":"2456","DOI":"10.1093\/eurheartj\/ehl570","article-title":"Tako-Tsubo cardiomyopathy: intraindividual structural analysis in the acute phase and after functional recovery","volume":"28","author":"Nef","year":"2007","journal-title":"Eur Heart J"},{"key":"2023072413345683500_jead035-B29","doi-asserted-by":"crossref","first-page":"1635","DOI":"10.1093\/eurheartj\/ehp140","article-title":"Immunohistological basis of the late gadolinium enhancement phenomenon in tako-tsubo cardiomyopathy","volume":"30","author":"Rolf","year":"2009","journal-title":"Eur Heart J"},{"key":"2023072413345683500_jead035-B30","doi-asserted-by":"crossref","DOI":"10.1186\/1532-429X-14-42","article-title":"Non-contrast T1-mapping detects acute myocardial edema with high diagnostic accuracy: a comparison to T2-weighted cardiovascular magnetic resonance","volume":"14","author":"Ferreira","year":"2012","journal-title":"J Cardiovasc Magn Reson"},{"key":"2023072413345683500_jead035-B31","doi-asserted-by":"crossref","DOI":"10.1016\/j.ijcard.2020.03.002","article-title":"Native T1 and T2 provide distinctive signatures in hypertrophic cardiac conditions\u2014comparison of uremic, hypertensive and hypertrophic cardiomyopathy","volume":"306","author":"Arcari","year":"2020","journal-title":"Int J Cardiol"},{"key":"2023072413345683500_jead035-B32","doi-asserted-by":"crossref","first-page":"1800","DOI":"10.1016\/j.jacc.2016.02.013","article-title":"Comprehensive cardiac magnetic resonance imaging in patients with suspected myocarditis: the MyoRacer-trial","volume":"67","author":"Lurz","year":"2016","journal-title":"J Am Coll Cardiol"},{"key":"2023072413345683500_jead035-B33","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.ijcard.2020.07.025","article-title":"The early dynamic of ECG in takotsubo syndrome presenting with ST-elevation: a comparison with age and gender-matched ST-elevation myocardial infarction","volume":"320","author":"Scally","year":"2020","journal-title":"Int J Cardiol"},{"key":"2023072413345683500_jead035-B34","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.ijcard.2015.05.101","article-title":"Transient apical wall thickening in patients with stress cardiomyopathy: prevalence, profile, and impact on clinical course","volume":"194","author":"Shin","year":"2015","journal-title":"Int J Cardiol"},{"key":"2023072413345683500_jead035-B35","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1186\/s12968-021-00762-z","article-title":"Cardiac biomarkers in chronic kidney disease are independently associated with myocardial edema and diffuse fibrosis by cardiovascular magnetic resonance","volume":"23","author":"Arcari","year":"2021","journal-title":"J Cardiovasc Magn Reson"},{"key":"2023072413345683500_jead035-B36","doi-asserted-by":"crossref","first-page":"1388","DOI":"10.1038\/s41598-018-37845-4","article-title":"Acute changes in cardiac structural and tissue characterisation parameters following haemodialysis measured using cardiovascular magnetic resonance","volume":"9","author":"Kotecha","year":"2019","journal-title":"Sci Rep"},{"key":"2023072413345683500_jead035-B37","doi-asserted-by":"crossref","first-page":"1368","DOI":"10.1253\/circj.CJ-17-0065","article-title":"Myocardial edema in takotsubo syndrome-serial cardiovascular magnetic resonance imaging of the natural course","volume":"81","author":"Kato","year":"2017","journal-title":"Circ J"},{"key":"2023072413345683500_jead035-B38","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1093\/cvr\/cvq145","article-title":"Myocardial microvascular permeability, interstitial oedema, and compromised cardiac function","volume":"87","author":"Dongaonkar","year":"2010","journal-title":"Cardiovasc Res"},{"key":"2023072413345683500_jead035-B39","doi-asserted-by":"crossref","DOI":"10.1007\/s10741-020-09988-y","article-title":"A systematic review on focal takotsubo syndrome: a not-so-small matter","volume":"27","author":"Tini","year":"2022","journal-title":"Heart Fail Rev"},{"key":"2023072413345683500_jead035-B40","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1016\/j.ijcard.2013.08.126","article-title":"Time course of electrocardiographic changes in transient left ventricular ballooning syndrome","volume":"169","author":"Bennett","year":"2013","journal-title":"Int J Cardiol"},{"key":"2023072413345683500_jead035-B41","doi-asserted-by":"crossref","DOI":"10.1016\/j.jelectrocard.2022.06.002","article-title":"ECG In left ventricular hypertrophy: a change in paradigm from assessing left ventricular mass to its electrophysiological properties","volume":"73","author":"Bacharova","year":"2022","journal-title":"J Electrocardiol"},{"key":"2023072413345683500_jead035-B42","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.116.003795","article-title":"Diffuse myocardial fibrosis reduces electrocardiographic voltage measures of left ventricular hypertrophy independent of left ventricular mass","volume":"6","author":"Maanja","year":"2017","journal-title":"J Am Heart Assoc"},{"key":"2023072413345683500_jead035-B43","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.jcmg.2019.10.023","article-title":"CMR In nonischemic myocardial inflammation: solving the problem of diagnosing myocarditis or still diagnostic ambiguity?","volume":"13","author":"Nagel","year":"2020","journal-title":"JACC Cardiovasc Imaging"}],"container-title":["European Heart Journal - Cardiovascular Imaging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjcimaging\/article-pdf\/24\/8\/1082\/50946308\/jead035.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcimaging\/article-pdf\/24\/8\/1082\/50946308\/jead035.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,7,24]],"date-time":"2023-07-24T13:36:03Z","timestamp":1690205763000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcimaging\/article\/24\/8\/1082\/7067310"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,2]]},"references-count":43,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2023,3,2]]},"published-print":{"date-parts":[[2023,7,24]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjci\/jead035","relation":{},"ISSN":["2047-2404","2047-2412"],"issn-type":[{"value":"2047-2404","type":"print"},{"value":"2047-2412","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,8]]},"published":{"date-parts":[[2023,3,2]]}}}