title: Myocardial oedema as the sole marker of acute injury in Takotsubo cardiomyopathy: a cardiovascular magnetic resonance (CMR) study.
abstract: OBJECTIVE
  The main hallmark of Takotsubo cardiomyopathy (TT-CMP) is transient ischaemia, with completely reversible regional contractile dysfunction, which involves the mid-apical segments and shows no angiographic signs of coronary artery disease (CAD). The acute and reversible myocardial injury suggests that tissue oedema may be an important marker of disease.
  
  
  METHODS
  Seventeen patients with a clinical and angiographic diagnosis of TT-CMP underwent cardiovascular magnetic resonance (CMR) imaging in the acute phase and at follow-up after 4 months. A standard acquisition protocol including turbo spin echo (TSE) T2-weighted short-tau inversion-recovery (T2 STIR), steady-state free-precession cine (SSFP cine) and lateenhancement (LE) imaging after gadolinium benzyloxypropionic tetraacetic acid (Gd-BOPTA) administration was performed. All images were analysed, and data on oedema and LE were correlated with regional dysfunction and histological findings from endomyocardial biopsy (EMB) where available.
  
  
  RESULTS
  In all patients, T2 STIR images showed a diffuse homogeneous hyperintensity that extended to all mid-apical segments and perfectly matched the area of regional dysfunction, reflecting tissue oedema. In the five patients who underwent EMB, histology confirmed the massive interstitial oedema associated with typical contraction-band necrosis. No cases of LE were observed. At follow-up, complete regression of oedema was observed in all cases, with significant recovery of regional and global left ventricular (LV) function (ejection fraction from 48.7% to 59.8%).
  
  
  CONCLUSIONS
  Myocardial oedema on CMR is a characteristic feature of acute TT-CMP, which reflects acute inflammation and acute myocardial injury. It could therefore be used as a specific marker of disease severity.
authors.affiliation: Dipartimento di Scienze Radiologiche Oncologiche ed Anatomo-Patologiche, Sapienza, Università degli Studi di Roma, V.le Regina Elena 324, 00161, Roma, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Iacucci
authors.forename: Iacopo
authors.initials: I
authors.lastname: Carbone
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cannavale
authors.forename: Bettina
authors.initials: B
authors.lastname: Conti
authors.forename: Ilaria
authors.initials: I
authors.lastname: Iampieri
authors.forename: Riccardo
authors.initials: R
authors.lastname: Rosati
authors.forename: Gennaro
authors.initials: G
authors.lastname: Sardella
authors.forename: Andrea
authors.initials: A
authors.lastname: Frustaci
authors.forename: Francesco
authors.initials: F
authors.lastname: Fedele
authors.forename: Carlo
authors.initials: C
authors.lastname: Catalano
authors.forename: Marco
authors.initials: M
authors.lastname: Francone
mesh_terms: D000368:Aged; D001706:Biopsy; D003287:Contrast Media; D017023:Coronary Angiography; D004489:Edema, Cardiac / Q000473:pathology*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008536:Meglumine / Q000031:analogs & derivatives; D008875:Middle Aged; D009942:Organometallic Compounds; D012720:Severity of Illness Index; D054549:Takotsubo Cardiomyopathy / Q000473:pathology*
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C064572:gadobenic acid; D008536:Meglumine