Abstract 3287: Dynamic Study of Myocardial Contrast-Enhancement in Takotsubo-Cardiomyopathy: Reversible Myocardial Injury Detected by T2W Images and Early Gadolinium Enhancement
Background: Although gadolinium(Gd)-enhancement (GE) by cardiac magnetic resonance (CMR) can visualize myocardial infarction, this technique cannot distinguish abnormal wall motion area from normal myocardium in Takotsubo-cardiomyopathy (TCM). To address this, we measured the signal intensity (SI) in the abnormal wall motion area in TCM patients at early phase of GE (i.e., 2–5min after Gd injection) and to evaluate the usefulness of T2-weighting image (T2WI).
Methods: Cine CMR, T2WI, and GE were assessed in 20 patients with TCM and 10 age-matched controls. GE was analyzed at 2, 5, 10, 20 min after contrast injection. To measure SI in myocardium, we put region of interest on the myocardium segments #1, 2, 4, 5 of the American Heart Association and on blood pool, and calculated myocardium-to-blood pool ratio (M/B).
Results: In TCM, conventional GE at 20 min representing myocardial necrosis/fibrosis was not observed. However, on the early phase GE apical ballooning region in TCM was visualized as homogenous hyperenhancement, whereas such hyperenhancement was not observed in controls. M/B ratio in apical ballooning region in TCM was significantly higher than that in controls (Figure⇓). Furthermore, this hyperenhancement region agreed well with the region of high intensity signals on T2WI. Follow-up CMR demonstrated complete resolution of wall motion abnormalities within 1 month and disappearance of hyperenhancement on early phase of GE and on T2WI within 3 months.
Conclusion: Apical ballooning area in TCM is visualized by early phase of GE and T2WI as hyperenhanced area. Thus, combination of these techniques is useful to detect a reversible myocardial damage in TCM patients.