Prognostic Value of Hepatic T1 Mapping in Patients with Takotsubo Syndrome

Objective: Takotsubo syndrome (TTS) is an acute form of heart failure characterized by transient left ventricular systolic dysfunction. Given the complex cardiohepatic interactions observed in heart failure, this study aimed to evaluate the prognostic significance of hepatic T1 mapping in patients with TS. Materials and Methods: In this retrospective pilot study, cardiovascular magnetic resonance (CMR) including hepatic T1 mapping was performed in 66 consecutive patients with TTS (60 females; mean age 70.96 ± 10.11 years). The median duration of long-term follow-up was 7 months (interquartile range, 2-16 months). The primary endpoint was a composite of out-of-hospital all-cause mortality and major cardiovascular or cerebrovascular adverse events, including heart failure hospitalization, TTS recurrence, and ischemic stroke. Results: During the median follow-up period of 7 months, 12 (18%) patients experienced the primary endpoint. Kaplan-Meier analysis revealed a significantly lower event-free survival in patients with higher hepatic T1 values (log-rank, p = 0.001). In multivariable Cox regression analysis, hepatic T1 mapping emerged as an independent predictor of adverse outcomes (HR 1.010; 95% CI 1.002-1.017, p = 0.010). Conclusions: Elevated hepatic T1 mapping values were independently associated with an increased risk of adverse cardiovascular events during follow-up. Incorporating hepatic T1 mapping into the clinical evaluation of patients with TTS may improve risk stratification and support more personalized management strategies.