Slowly resolving global myocardial inflammation/oedema in Tako-Tsubo cardiomyopathy: evidence from T2-weighted cardiac MRI.
OBJECTIVE
Tako-Tsubo cardiomyopathy (TTC) is associated with regional left ventricular dysfunction, independent of the presence of fixed coronary artery disease. Previous studies have used T2-weighted cardiac MRI to demonstrate the presence of periapical oedema. The authors sought to determine the distribution, resolution and correlates of oedema in TTC.


METHODS
32 patients with TTC were evaluated at a median of 2 days after presentation, along with 10 age-matched female controls. Extent of oedema was quantified both regionally and globally; scanning was repeated in patients with TTC after 3 months. Correlations were sought between oedema and the extent of hypokinesis, catecholamine release, release of N-terminal prohormone of B-type natriuretic peptide (NT-proBNP), and markers of systemic inflammatory activation (high-sensitivity C-reactive protein and platelet response to nitric oxide).


RESULTS
In the acute phase of TTC, T2-weighted signal intensity was greater at the apex than at the base (p<0.0001) but was nevertheless significantly elevated at the base (p<0.0001), relative to control values. Over 3 months, T2-weighted signal decreased substantially, but remained abnormally elevated (p<0.02). The regional extent of oedema correlated inversely with radial myocardial strain (except at the apex). There were also direct correlations between global T2-weighted signal and (1) plasma normetanephrine (r=0.39, p=0.04) and (2) peak NT-proBNP (r=0.39, p=0.03), but not with systemic inflammatory markers.


CONCLUSIONS
TTC is associated with slowly resolving global myocardial oedema, the acute extent of which correlates with regional contractile disturbance and acute release of both catecholamines and NT-proBNP.
The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, SA 5011, Australia.
Christopher
C
Neil
Thanh Ha
TH
Nguyen
Angela
A
Kucia
Benjamin
B
Crouch
Aaron
A
Sverdlov
Yuliy
Y
Chirkov
Gnanadevan
G
Mahadavan
Joseph
J
Selvanayagam
Dana
D
Dawson
John
J
Beltrame
Christopher
C
Zeitz
Steven
S
Unger
Thomas
T
Redpath
Michael
M
Frenneaux
John
J
Horowitz
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000032:analysis; D016022:Case-Control Studies; D004487:Edema / Q000473:pathology*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000473:pathology*; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D020097:Natriuretic Peptide, Brain / Q000097:blood; D009647:Normetanephrine / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D054549:Takotsubo Cardiomyopathy / Q000473:pathology*
D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D009647:Normetanephrine; D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein