title: Takotsubo cardiomyopathy, a two-stage recovery of left ventricular systolic and diastolic function as determined by cardiac magnetic resonance imaging.
abstract: OBJECTIVE
  Takotsubo cardiomyopathy (TTC) is an entity mimicking acute myocardial infarction, characterized by transient severe systolic heart failure. Echocardiographic studies suggest that diastolic dysfunction is present in TTC at presentation; however, no reports exist regarding the time course of left ventricular (LV) recovery. This study describes the recovery of LV systolic and diastolic function in TTC. We hypothesized that, in TTC, there is diastolic dysfunction at admission, and that recovery is delayed compared with systolic function.
  
  
  RESULTS
  We enrolled (consecutively 2010-12) 16 patients (mean age 66, range 39-84 years) diagnosed with TTC and 20 healthy matched controls. We performed cardiac magnetic resonance imaging (CMR) at admission, pre-discharge, and 3-month follow-up. Diastolic function was assessed by LV peak filling rate (LVPFR) and left atrial (LA) emptying volumes. At admission, LV ejection fraction was low, increased at pre-discharge (37 ± 6 vs. 58 ± 6%, P < 0.001), and normalized at follow-up (to 65 ± 5%, P = 0.01). LVPFR did not increase during hospitalization (80 ± 3 vs. 89 ± 4 mL/s/m(2), P = 0.21), but was normalized at follow-up (to 206 ± 19, P < 0.001; controls, 214 ± 13, P = 0.23). During hospitalization, LA passive emptying volume remained low (6 ± 2 vs. 8 ± 3 mL/m(2), P = 0.05) and LA active emptying volume remained high (17 ± 3 vs. 16 ± 3 mL/m(2), P = 0.71), whereas LA conduit volume increased (7 ± 3 vs. 23 ± 4 mL/m(2), P < 0.001). T2-weighted imaging demonstrated non-coronary distributed apical oedema without contrast enhancement.
  
  
  CONCLUSIONS
  Patients with TTC undergo fast systolic recovery. However, at discharge, profound diastolic dysfunction is demonstrated by CMR. At follow-up, both LV systolic and diastolic function is normalized in patients with recovered TTC.
authors: Department of Cardiology, Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark kirilaleksov@live.dk.
authors: Kiril Aleksov
authors: KA
authors: Ahtarovski
authors: Department of Cardiology, Hillerød Hospital, Hillerød, Denmark.
authors: Kasper Karmark
authors: KK
authors: Iversen
authors: Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Copenhagen, Denmark.
authors: Thomas Emil
authors: TE
authors: Christensen
authors: Department of Cardiology, Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark.
authors: Hedvig
authors: H
authors: Andersson
authors: Department of Cardiology, Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark.
authors: Peer
authors: P
authors: Grande
authors: Department of Cardiology, Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark.
authors: Lene
authors: L
authors: Holmvang
authors: Department of Cardiology, Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark.
authors: Lia
authors: L
authors: Bang
authors: Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Copenhagen, Denmark.
authors: Philip
authors: P
authors: Hasbak
authors: Department of Cardiology, Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark.
authors: Jacob Thomsen
authors: JT
authors: Lønborg
authors: Department of Cardiology, Hvidovre Hospital, Copenhagen, Denmark.
authors: Per Lav
authors: PL
authors: Madsen
authors: Department of Cardiology, Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark.
authors: Thomas
authors: T
authors: Engstrøm
authors: Department of Cardiology, Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark.
authors: Niels Grove
authors: NG
authors: Vejlstrup
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003287:Contrast Media; D003718:Denmark; D003971:Diastole; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds; D011446:Prospective Studies; D020127:Recovery of Function; D013599:Systole; D054549:Takotsubo Cardiomyopathy / Q000503:physiopathology*; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology*
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C090600:gadobutrol
keywords: Cardiac magnetic resonance imaging; Diastolic dysfunction; Left atrium; Left ventricle; Takotsubo cardiomyopathy