The clinical impact of late gadolinium enhancement in Takotsubo cardiomyopathy: serial analysis of cardiovascular magnetic resonance images.
BACKGROUND
Our study aimed to investigate both the clinical implications of late gadolinium enhancement (LGE) by cardiovascular magnetic resonance (CMR) and the relation of LGE to clinical findings in patients with Takotsubo cardiomyopathy (TTC).


METHODS
We evaluated 20 consecutive patients (2 men, 18 women; median age, 77 years; interquartile range [IQR] 67-82 years) who were admitted to our hospital with the diagnosis of TTC. CMR was performed within 1 week after admission, and follow-up studies were conducted 1.5 and 6 months later.


RESULTS
In 8 patients, CMR imaging during the sub-acute phase revealed LGE in the area matched with wall motion impairment. Cardiogenic shock was more frequently observed in patients with LGE than in those without LGE (38% vs 0%, p = 0.049). The patients with LGE needed a longer duration for ECG normalization and recovery of wall motion than did those without LGE (median 205 days, IQR [152-363] vs 68 days, [43-145], p = 0.005; 15 days, [10-185] vs 7 days, [4-13], p = 0.030, respectively). In 5 of these 8 patients, LGE disappeared within 45-180 days (170, IQR [56-180]) of onset. The patients with LGE remaining in the chronic phase had higher peak creatine kinase levels than did those without LGE (median 307 IU/L, IQR [264-460] vs 202 IU/L, [120-218], p = 0.017).


CONCLUSIONS
LGE by CMR in the sub-acute phase may be associated with the severity and prolonged recovery to normal of clinical findings in TTC.
Cardiovascular Division, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan.
Yoshihisa
Y
Naruse
Akira
A
Sato
Kazuyuki
K
Kasahara
Kiwa
K
Makino
Makoto
M
Sano
Yasuyo
Y
Takeuchi
Shiro
S
Nagasaka
Yasushi
Y
Wakabayashi
Hideki
H
Katoh
Hiroshi
H
Satoh
Hideharu
H
Hayashi
Kazutaka
K
Aonuma
D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D019786:Gadolinium DTPA; D006329:Heart Conduction System / Q000503:physiopathology; D006801:Humans; D007564:Japan; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function; D012720:Severity of Illness Index; D013318:Stroke Volume; D054549:Takotsubo Cardiomyopathy / Q000175:diagnosis* / Q000503:physiopathology; D013997:Time Factors; D016277:Ventricular Function, Left
D003287:Contrast Media; D019786:Gadolinium DTPA