title: Inflammation in takotsubo cardiomyopathy: insights from cardiovascular magnetic resonance imaging.
abstract: 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.
authors.affiliation: Department of Internal Medicine/Cardiology, University of Leipzig-Heart Centre, Strümpellstr. 39, 04289 Leipzig, Germany. ingoeitel@gmx.de
authors.forename: Ingo
authors.initials: I
authors.lastname: Eitel
authors.forename: Christian
authors.initials: C
authors.lastname: Lücke
authors.forename: Matthias
authors.initials: M
authors.lastname: Grothoff
authors.forename: Mahdi
authors.initials: M
authors.lastname: Sareban
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuler
authors.forename: Holger
authors.initials: H
authors.lastname: Thiele
authors.forename: Matthias
authors.initials: M
authors.lastname: Gutberlet
mesh_terms: 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*
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