Purpose: The aim of this study is to define the correlation between visual qualitative method and semi-quantitative method for the study of the extension of myocardial edema in patients with TTS.
Methods: We retrospectively included all consecutive patients admitted between January 2013 and March 2016 with a diagnosis of TSS (according to the criteria of the Mayo Clinic), to whom, in the acute phase, a CMR was performed with a specific T2-weighted sequence for edema (double inversion recovery with fat suppression). Patients without myocardial edema according to the visual method were excluded from the analysis. The extent of the edema was expressed as number of myocardial segments involved using the 17-segments cardiac segmentation model. The quantification of the edema was performed both by visual signal intensity and by the semi-quantitative T2 signal intensity ratio (a value > 1.9 was considered positive for the presence of edema). All the analysis were blind and independent.
Results: 21 patients were included in the analysis. The median of myocardial segments with edema was 5 (1-11) using the qualitative method and 6 (0-12) using the semi-quantitative method. The results showed a positive correlation between the extent of myocardial edema measured by the visual method and the semi-quantitative method of the T2 ratio (Pearson's r = 0.78, p <0.001) (figure).
Conclusions: The visual qualitative method presents a high correlation with the semi-quantitative method in the study of myocardial edema by CMR in patients with TTS. Therefore, the visual method allows a valid quantification of myocardial edema extension in patients with TTS.