The clinical impact of late gadolinium enhancement in Takotsubo cardiomyopathy: serial analysis of cardiovascular magnetic resonance images

Abstract

BackgroundOur 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).MethodsWe 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.ResultsIn 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).ConclusionLGE by CMR in the sub-acute phase may be associated with the severity and prolonged recovery to normal of clinical findings in TTC.

Left ventricular function after takotsubo is not fully recovered in long-term follow-up: A speckle tracking echocardiography study

“…Focal late gadolinium enhancement in cardiac magnetic resonance, which is believed to be evidence of irreversible fibrosis, is observed in 9-40% of patients with TTC [24][25][26][27]. Cardiac rupture is the most severe and oftentimes fatal complication of TTC, which supports the transmyocardial damage [28,29].…”

Infarct‐like Acute Myocarditis: Relation Between Electrocardiographic Findings and Myocardial Damage as Assessed by Cardiac Magnetic Resonance Imaging

“…9 -14 Interestingly, Naruse and colleagues recently observed a relation between time to ECG normalization and LGE among patients with Takotsubo cardiomyopathy as well. 30 Third, none of the patients included in the present study developed pathologic Q waves. Moon et al have shown that the presence of Q wave in ischemic heart disease is mainly related to the extent of infarct size and, secondarily, to its transmural extent 31 ; accordingly, the scattered nature and the absence of transmurality of myocardial damage in AM may explain the lack of development of Q waves in this group of patients.…”

TakoTsubo cardiomyopathy: unravelling the malignant consequences of a benign disease with cardiac magnetic resonance

“…However, the signal intensity of LGE was lower than that Fig. 3 a Four-chamber view showing mid-apical oedema in T2-weighted sequences and b no evidence of significant late gadolinium enhancement in T1-weighted inversion recovery post-contrast sequences usually documented in cases of MI or myocarditis [21]. Whilst initially it was believed that lack of LGE was a necessary condition to diagnose TCM and would thus help differentiate it from MI, in the study by Haghi et al [22], 88 % of patients showed a patchy type of LGE.…”