title: Clinical characteristics and cardiovascular magnetic resonance findings in stress (takotsubo) cardiomyopathy.
abstract: BACKGROUND
  Stress cardiomyopathy (SC) is a transient form of acute heart failure triggered by stressful events and associated with a distinctive left ventricular (LV) contraction pattern. Various aspects of its clinical profile have been described in small single-center populations, but larger, multicenter data sets have been lacking so far. Furthermore, it remains difficult to quickly establish diagnosis on admission.
  
  
  OBJECTIVE
  To comprehensively define the clinical spectrum and evolution of SC in a large population, including tissue characterization data from cardiovascular magnetic resonance (CMR) imaging; and to establish a set of CMR criteria suitable for diagnostic decision making in patients acutely presenting with suspected SC.
  
  
  METHODS
  Prospective study conducted at 7 tertiary care centers in Europe and North America between January 2005 and October 2010 among 256 patients with SC assessed at the time of presentation as well as 1 to 6 months after the acute event.
  
  
  METHODS
  Complete recovery of LV dysfunction.
  
  
  RESULTS
  Eighty-one percent of patients (n = 207) were postmenopausal women, 8% (n = 20) were younger women (aged ≤50 years), and 11% (n = 29) were men. A stressful trigger could be identified in 182 patients (71%). Cardiovascular magnetic resonance imaging data (available for 239 patients [93%]) revealed 4 distinct patterns of regional ventricular ballooning: apical (n = 197 [82%]), biventricular (n = 81 [34%]), midventricular (n = 40 [17%]), and basal (n = 2 [1%]). Left ventricular ejection fraction was reduced (48% [SD, 11%]; 95% confidence interval [CI], 47%-50%) in all patients. Stress cardiomyopathy was accurately identified by CMR using specific criteria: a typical pattern of LV dysfunction, myocardial edema, absence of significant necrosis/fibrosis, and markers for myocardial inflammation. Follow-up CMR imaging showed complete normalization of LV ejection fraction (66% [SD, 7%]; 95% CI, 64%-68%) and inflammatory markers in the absence of significant fibrosis in all patients.
  
  
  CONCLUSIONS
  The clinical profile of SC is considerably broader than reported previously. Cardiovascular magnetic resonance imaging at the time of initial clinical presentation may provide relevant functional and tissue information that might aid in the establishment of the diagnosis of SC.
authors.affiliation: University of Leipzig-Heart Center, Department of Internal Medicine/Cardiology, Strümpellstrasse 39, 04289 Leipzig, Germany. ingoeitel@gmx.de
authors.forename: Ingo
authors.initials: I
authors.lastname: Eitel
authors.forename: Florian
authors.initials: F
authors.lastname: von Knobelsdorff-Brenkenhoff
authors.forename: Peter
authors.initials: P
authors.lastname: Bernhardt
authors.forename: Iacopo
authors.initials: I
authors.lastname: Carbone
authors.forename: Kai
authors.initials: K
authors.lastname: Muellerleile
authors.forename: Annachiara
authors.initials: A
authors.lastname: Aldrovandi
authors.forename: Marco
authors.initials: M
authors.lastname: Francone
authors.forename: Steffen
authors.initials: S
authors.lastname: Desch
authors.forename: Matthias
authors.initials: M
authors.lastname: Gutberlet
authors.forename: Oliver
authors.initials: O
authors.lastname: Strohm
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuler
authors.forename: Jeanette
authors.initials: J
authors.lastname: Schulz-Menger
authors.forename: Holger
authors.initials: H
authors.lastname: Thiele
authors.forename: Matthias G
authors.initials: MG
authors.lastname: Friedrich
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004487:Edema / Q000209:etiology; D005260:Female; D005355:Fibrosis / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D009336:Necrosis / Q000209:etiology; D011446:Prospective Studies; D013315:Stress, Psychological; D013318:Stroke Volume; D054549:Takotsubo Cardiomyopathy / Q000150:complications / Q000175:diagnosis* / Q000473:pathology