Abstract 14260: The Clinical Value of Late Gadolinium Hyper-enhancement in Takotsubo Cardiomyopathy: The Serial Analyses of Cardiac Magnetic Resonance Imaging
Background: Takotsubo cardiomyopathy (TTC) is a condition that mimics acute coronary syndrome typically without coronary stenosis. The histological analysis of the heart in TTC has shown sparse foci of contraction-band necrosis and transient fibrosis. Recently, delayed hyper-enhancement (DE) on late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) imaging has been shown to be able to detect a small myocardial abnormality, and to be useful to diagnose various cardiac diseases. However in TTC the clinical implication of DE on LGE-CMR, and the relationship with clinical findings remain still unknown.
Methods: We prospectively evaluated 20 consecutive patients who admitted to our hospital with the diagnosis of TTC. The CMR imaging was performed within 1 week after the admission, and follow up studies were conducted at 1.5, 6 months. We calculated the percentage of DE tissue area for total left ventricular myocardium (DE area ratio).
Results: In 8 patients, LGE-CMR demonstrated DE in matched area with wall motion impairment during a sub-acute phase. In patients with DE, cardiogenic shock was more frequently observed than those with no DE (63% vs 8%, P=0.04). The patients with DE had a longer duration to ECG normalization and recovery of wall motion than those with no DE (mean 205, IQR [152–363] vs 68 [43–145], P=0.006, 15 [10–185] vs 7 [4–13], P=0.03, respectively). The DE area ratio in the sub-acute phase was 5–24% (13, IQR 7–17). A significant positive correlation was observed between the DE area ratio in the sub-acute phase and the duration for normalization both in electrocardiogram (r=0.738, p=0.037) and echocardiogram (r=0.762, p=0.028). In 5 of 8 cases, delayed enhancement disappeared in 16–150 days (140, IQR 56–150 days) from the onset. The remaining 3 patients with remaining DE in the chronic phase had a higher peak creatine kinese levels compared with non-DE in the chronic phase (307, IQR 264–460, versus 202, IQR 120–218, P=0.033).
Conclusions: DE of LGE-CMR in sub-acute phase may be associated with cardiogenic shock and provide promising information to predict recovery of clinical findings in TTC.
- © 2010 by American Heart Association, Inc.