title: Morphologic pattern of late gadolinium enhancement in Takotsubo cardiomyopathy detected by early cardiovascular magnetic resonance.
abstract: BACKGROUND
  Takotsubo cardiomyopathy (TTC) presents clinically as an acute coronary syndrome. It is characterized by transient left ventricular wall dyskinesis-akinesis, without significant epicardial coronary lesions. Late gadolinium enhancement (LGE) sequences on cardiac magnetic resonance (CMR) allow to clarify the pathophysiology in patients with chest pain, elevated troponin, and normal epicardial coronary arteries; in patients with TTC, previous studies have shown absence of LGE.
  
  
  OBJECTIVE
  Early CMR in Takotsubo patients could show a morphological pattern of LGE improving clinical diagnosis.
  
  
  METHODS
  Between January 2005 and January 2007, 8 consecutive patients with TTC criteria underwent CMR within the first 3 days of admission. Cine, T2-weighted, and LGE images were acquired. Patient follow-up included clinical exam and imaging techniques: echocardiogram on days 3, 7, 30, and 60, and CMR at 3 months.
  
  
  RESULTS
  Six patients had experienced a previous stressful situation. No significant lesions were found on coronary angiography, and wall motion improvement was noted at 15 (7-30) days. Median EFs at admission and recovery were 46.5% and 65%, respectively. Dyskinesis was midapical in 6 cases, apical in 1 case, and mid-ventricular in 1 case. Late gadolinium enhancement showed mild hyperenhancement in areas of abnormal wall motion, whereas normal segments had no contrast enhancement. On follow-up CMR, wall motion was normal without late enhancement.
  
  
  CONCLUSIONS
  Early CMR in TTC demonstrates a special morphological pattern of late gadolinium uptake that might correspond to localized inflammation and edema in the affected area, suggesting diffuse microcirculation damage rather than epicardial vessel involvement.
authors.affiliation: Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina. avelink@hotmail.com
authors.forename: Gustavo
authors.initials: G
authors.lastname: Avegliano
authors.forename: Marina
authors.initials: M
authors.lastname: Huguet
authors.forename: Juan P
authors.initials: JP
authors.lastname: Costabel
authors.forename: Ricardo
authors.initials: R
authors.lastname: Ronderos
authors.forename: Bart
authors.initials: B
authors.lastname: Bijnens
authors.forename: Paola
authors.initials: P
authors.lastname: Kuschnir
authors.forename: Jorge
authors.initials: J
authors.lastname: Thierer
authors.forename: Carolina
authors.initials: C
authors.lastname: Tobón-Gomez
authors.forename: Guillermo Oller
authors.initials: GO
authors.lastname: Martinez
authors.forename: Alejandro
authors.initials: A
authors.lastname: Frangi
mesh_terms: D000368:Aged; D003287:Contrast Media; D005260:Female; D005500:Follow-Up Studies; D019786:Gadolinium DTPA; D006801:Humans; D007089:Image Enhancement; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D054549:Takotsubo Cardiomyopathy / Q000175:diagnosis* / Q000503:physiopathology
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA