title: Takotsubo cardiomyopathy in acute coronary syndrome; clinical features and contribution of cardiac magnetic resonance during the acute and convalescent phase.
abstract: OBJECTIVE
  Takotsubo cardiomyopathy (TTC) is a diagnostic entity that is increasingly being recognized. Data from cardiac magnetic resonance (CMR) imaging and its impact on differential diagnosis are limited.
  
  
  RESULTS
  After 26 months, coronary angiography revealed normal coronary arteries and left ventriculography and/or echocardiography left ventricular dysfunction with apical ballooning in 20 patients with acute coronary syndrome (ACS). Four patients were excluded from CMR and in three patients an alternative diagnosis was revealed. Thirteen patients (all female; 60 ± 8 years) with TTC underwent a multisequential CMR, in which all showed myocardial oedema with an elevated T2 ratio in the apical region (2.4 ± 0.4; p < 0.001 vs. healthy controls), and five patients an elevated global relative enhancement (gRE; 3.7 ± 1.4; p < 0.05 vs. healthy controls). No late gadolinium enhancement (LGE) was detected on CMR. Follow-up after 132 ± 33 days showed a normalized left ventricular ejection fraction, myocardial mass, T2 ratio, and gRE in all patients.
  
  
  CONCLUSIONS
  TTC is a small but definite group among patients with ACS and normal coronary arteries. CMR allows differentiating TTC from other causes such as myocarditis and cardiomyopathies, as well as to identify the transient increase of myocardial mass and resolution of myocardial oedema as the systolic dysfunction improves. Therefore, CMR might add valuable information for the differential diagnoses and therapeutic decision-making in patients with suspected TTC.
authors.affiliation: Department of Radiology, Section of Cardiovascular Radiology, Oslo University Hospital, Ullevaal, Oslo, Norway. k.h.stensath@medisin.uio.no
authors.forename: Knut Haakon
authors.initials: KH
authors.lastname: Stensæth
authors.forename: Eigil
authors.initials: E
authors.lastname: Fossum
authors.forename: Pavel
authors.initials: P
authors.lastname: Hoffmann
authors.forename: Arild
authors.initials: A
authors.lastname: Mangschau
authors.forename: Per Torger
authors.initials: PT
authors.lastname: Skretteberg
authors.forename: Nils Einar
authors.initials: NE
authors.lastname: Kløw
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D054549:Takotsubo Cardiomyopathy / Q000175:diagnosis*; D013997:Time Factors