Hepatic T1 Mapping in Takotsubo Syndrome: A Preliminary Imaging Insight into the Cardiohepatic Axis

<b>Background:</b> Takotsubo syndrome (TS) is an acute heart failure characterized by transient systolic dysfunction of the left ventricle (LV). Given the complex cardiohepatic interactions in heart failure, the purpose of this study was to examine the role of hepatic T1 mapping in TS patients as an imaging biomarker of the cardiohepatic axis and to explore its correlation with demographics, laboratory data, and cardiovascular magnetic resonance (CMR) findings. <b>Methods:</b> In this retrospective pilot study, CMR was performed in 62 consecutive patients with TS (54 females, 73.47 ± 9.88 years). Additionally, 24 age- and sex-matched control subjects were included (20 females, 69.67 ± 6.88 years). A dedicated CMR software (CV42 6.0, CVI42, Circle Cardiovascular Imaging Inc., Calgary, AB, Canada) was used to assess atrial and ventricular strain parameters, as well as parametric mapping, including hepatic T1 mapping. <b>Results:</b> TS patients exhibited significantly higher hepatic T1 mapping values compared with the age-, sex-, and cardiovascular risk factor-matched control group (499.80 ± 141.86 vs. 425.26 ± 51.91, <i>p</i> = 0.017). In multivariable analysis, hepatic T1 mapping was independently associated with right ventricular (RV) longitudinal strain (β coefficient = 2.936, <i>p</i> = 0.007) and N-terminal pro-B-type natriuretic peptide (β coefficient = 2.395, <i>p</i> = 0.024). <b>Conclusions:</b> In this pilot study, hepatic T1 mapping was elevated in TS patients, suggesting its potential role as an imaging biomarker of cardiohepatic interaction. Hepatic T1 also showed independent associations with RV longitudinal strain and N-terminal pro-B-type natriuretic peptide, both well-known markers of adverse outcomes in TS. These preliminary findings warrant validation in larger studies.