An Update on Cardiac Magnetic Resonance Imaging in Takotsubo Cardiomyopathy

Abstract

Purpose of Review To provide an update on the use of cardiac magnetic resonance imaging in the diagnosis of Takotsubo cardiomyopathy. Recent Findings Long-term prognosis of Takotsubo cardiomyopathy may not be as clear-cut as previously thought. Cardiac magnetic resonance imaging not only allows differentiation between reversible and nonreversible changes but has an emerging role in identifying cellular level changes associated with prognostic indicators such as myocardial energetics using 31P-CMR spectroscopy and detection of myocardial inflammation overlying myocardial oedema, using ultrasmall paramagnetic iron oxide particle uptake in macrophages. Summary Takotsubo cardiomyopathy is a non-ischemic acute heart failure syndrome. It is commonly triggered by emotional or physical stress and is possibly the strongest psychosomatic interaction seen in medicine. While clinically its presentation mimics a myocardial infarction, the acute imaging characteristics are critical in correctly identifying the disease entity.

Takotsubo Syndrome: A Review of Presentation, Diagnosis and Management

“…Whilst previously believed that an absence of LGE on CMR was critical for TTS, more recently LGE has been noted in the acute phase of patients with TTS in a transmural distribution appearing at the hinge points between the dyskinetic ballooning segments and the hypercontractile segments. 69 - 71 LGE in this setting is transient and resolves on serial imaging to confirm the diagnosis of TTS. Presence of LGE in the acute setting has been associated with increased incidence cardiogenic shock and a longer timeframe for resolution of wall motion abnormalities.…”

“…These thrombi will appear as a low signal intensity without gadolinium uptake, in comparison to the high intensity signal from the blood pool. 67 , 69 …”

A valuable cardiac magnetic resonance investigation after MINOCA/takotsubo Syndrome: a case report

“…With respect to whether LGE may be a feature of late or resolved TTS, LGE has been uncommonly reported in TTS, with a distinctive transmural band appearing at the hinge points between the dyskinetic ballooning segments and the hypercontractile segments, so the pattern is unique to TTS 10 . We did not observe this pattern here, making this possibility unlikely.…”

Role of cardiac magnetic resonance imaging in troponinemia syndromes

“…In addition to confirming the diagnosis of TTS, CMRI is useful in identifying complications such as mitral regurgitation and LV outflow tract obstruction seen on blood flow imaging, pericardial effusion seen on black blood T1-weighted sequences, and ventricular (including apical) thrombi not visualised on TTE, during early gadolinium (EGE) sequences. Thrombi will appear as a low signal intensity without gadolinium uptake, in comparison to the high intensity signal from the blood pool[ 50 , 52 ].…”