Inflammation in takotsubo cardiomyopathy: insights from cardiovascular magnetic resonance imaging.
OBJECTIVE
Takotsubo cardiomyopathy (TTC) is an increasingly recognised acute cardiac syndrome, whose underlying pathophysiological mechanisms remain unknown. Inflammation might play a role as this has been shown in endomyocardial biopsies. The aim of this study was to assess inflammatory parameters in patients with TTC using a comprehensive cardiovascular magnetic resonance imaging (CMR) approach.


METHODS
Thirty-seven patients with the suspected diagnosis of TTC underwent CMR. T2-weighted imaging to calculate the oedema ratio, T1-weighted imaging before and after contrast agent administration to calculate the global relative enhancement (gRE), and late gadolinium enhancement (LGE) imaging were performed.


RESULTS
In 11 patients CMR revealed the diagnosis of myocardial infarction (n = 7; 19%) or myocarditis (n = 4; 11%) with typical patterns of LGE. In all other patients (n = 26; 70%), no LGE was detected consistent with the diagnosis of TTC. Of these, in 16 patients (62%) both inflammatory markers (oedema ratio and gRE) were elevated with concomitant pericardial effusion, indicating acute inflammation. Follow-up CMR after 3 months showed complete normalisation of left ventricular function and inflammatory parameters in the absence of LGE and pericardial effusion.


CONCLUSIONS
This CMR study provides further insights into the pathophysiological mechanisms in TTC, supporting the contribution of an inflammatory process in the acute setting.
Eitel
Ingo
I
Department of Internal Medicine/Cardiology, University of Leipzig-Heart Centre, Strümpellstr. 39, 04289 Leipzig, Germany. ingoeitel@gmx.de
Lücke
Christian
C
Grothoff
Matthias
M
Sareban
Mahdi
M
Schuler
Gerhard
G
Thiele
Holger
H
Gutberlet
Matthias
M
D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D009205:Myocarditis / Q000175:diagnosis* / Q000209:etiology*; D054549:Takotsubo Cardiomyopathy / Q000150:complications* / Q000175:diagnosis*
JACC Cardiovasc Imaging. 2009 Feb;2(2):131-8
19356545
J Nucl Cardiol. 2006 Mar-Apr;13(2):244-50
16580961
N Engl J Med. 2000 Nov 16;343(20):1445-53
11078769
J Magn Reson Imaging. 2007 Sep;26(3):452-9
17729358
Ann Intern Med. 2004 Dec 7;141(11):858-65
15583228
Mayo Clin Proc. 2006 Nov;81(11):1499-502
17120407
Radiology. 2008 Feb;246(2):401-9
18180335
J Am Coll Cardiol. 2006 Apr 18;47(8):1641-5
16631003
Int J Cardiol. 2007 Aug 21;120(2):205-11
17175045
Can J Cardiol. 2007 Apr;23(5):393-5
17440647
Circulation. 1998 May 12;97(18):1802-9
9603535
Jpn Circ J. 2000 Oct;64(10):789-92
11059622
N Engl J Med. 2005 Feb 10;352(6):539-48
15703419
J Am Coll Cardiol. 2005 Jun 7;45(11):1815-22
15936612
J Am Coll Cardiol. 2009 Apr 28;53(17):1475-87
19389557
Eur Heart J. 2008 Nov;29(21):2651-9
18820322
Eur Heart J. 2007 Nov;28(21):2598-604
17921529
Am Heart J. 2006 Sep;152(3):469.e9-13
16923415
Int J Cardiol. 2007 Mar 2;116(1):e18-21
17098306
Int J Cardiol. 2009 Feb 20;132(2):291-3
18086501
J Am Coll Cardiol. 2003 Mar 5;41(5):743-8
12628716
J Magn Reson Imaging. 2001 Oct;14(4):362-7
11599059
Radiology. 1996 Apr;199(1):49-57
8633172
Eur Heart J. 2007 Oct;28(20):2456-64
17395683
Eur Heart J. 2006 Jul;27(13):1523-9
16720686
Am Heart J. 2008 Mar;155(3):408-17
18294473