title: Immunohistological basis of the late gadolinium enhancement phenomenon in tako-tsubo cardiomyopathy.
abstract: OBJECTIVE
  Tako-tsubo cardiomyopathy is characterized by transient contractile dysfunction after emotional or physical stress. Only few patients show late gadolinium enhancement (LGE) in cardiovascular magnetic resonance imaging (MRI). It was the purpose of this study to elucidate the histological basis of this phenomenon.
  
  
  RESULTS
  The study included 15 patients. Tako-tsubo cardiomyopathy was diagnosed by coronary angiography and ventriculography. Cardiac MRI was performed within 24 h of admission. Endomyocardial biopsies were taken during the acute phase and after recovery. The content of fibrosis was determined by immunohistochemical staining of collagen-1. In the acute phase, cardiac MRI revealed LGE in five patients. This was completely reversed at follow-up [14, inter-quartile range (IQR) 11-14.5 days]. All patients showed a significant increase of collagen-1 compared with control tissue. Moreover, the amount of collagen-1 was significantly higher in LGE positive patients (LGE positive: 18.84, IQR 13.82-19.75 AU/microm(2); LGE negative: 7.57, IQR 5.41-9.19 AU/microm(2), P = 0.001). The presence of LGE was not associated with poorer left ventricular function.
  
  
  CONCLUSIONS
  The presence of LGE cannot rule out tako-tsubo cardiomyopathy. Instead it defines a special subgroup of patients with a disproportionate increase of extracellular matrix.
authors.affiliation: Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany. a.rolf@kerckhoff-klinik.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Rolf
authors.forename: Holger M
authors.initials: HM
authors.lastname: Nef
authors.forename: Helge
authors.initials: H
authors.lastname: Möllmann
authors.forename: Christian
authors.initials: C
authors.lastname: Troidl
authors.forename: Sandra
authors.initials: S
authors.lastname: Voss
authors.forename: Guido
authors.initials: G
authors.lastname: Conradi
authors.forename: Johannes
authors.initials: J
authors.lastname: Rixe
authors.forename: Holger
authors.initials: H
authors.lastname: Steiger
authors.forename: Katharina
authors.initials: K
authors.lastname: Beiring
authors.forename: Christian W
authors.initials: CW
authors.lastname: Hamm
authors.forename: Thorsten
authors.initials: T
authors.lastname: Dill
mesh_terms: D000368:Aged; D001706:Biopsy; D024042:Collagen Type I / Q000378:metabolism; D003287:Contrast Media; D017023:Coronary Angiography; D004719:Endomyocardial Fibrosis / Q000378:metabolism / Q000473:pathology; D005109:Extracellular Matrix / Q000473:pathology; D005260:Female; D005682:Gadolinium; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D054549:Takotsubo Cardiomyopathy / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology
chemical_list: D024042:Collagen Type I; D003287:Contrast Media; D005682:Gadolinium