Abstract 17542: Criteria for the CMR Diagnosis of Stress-induced (Takotsubo) cardiomyopathy: A Multicenter Series of 202 Patients in Europe and North America
Purpose: Stress-induced (Takotsubo, TTC) cardiomyopathy is an increasingly recognized acute cardiac syndrome. Cardiovascular magnetic resonance (CMR) allows for assessing irreversible injury (late gadolinium enhancement [LGE]) and myocardial edema and contributes to our understanding and differential diagnosis of this new entity. So far, various CMR criteria have been used in rather small populations. We aimed to establish CMR criteria for the diagnosis of TTC in a large series of TTC patients recruited by 7 CMR centers in Europe and North America.
Methods: Between 2005 and 2010, 203 patients (182 female, age 66±14 years) with acute cardiac symptoms and a LV dysfunction pattern not explained by coronary artery disease underwent CMR in a 1.5-T scanner. LV function, T2-weighted and LGE images after administration of gadolinium-DTPA were evaluated. In 89 patients, the recommended CMR criteria for acute myocarditis (Lake Louise Criteria) were analyzed. All patients had a clinical follow-up after 3–6 months including CMR in 103 (51%) patients.
Results: In 189 (93%) patients, cine images revealed a typical apical ballooning pattern, in 12 (6%) a midventricular and in 2 patients (1%) an “inverted”, basal pattern with moderate-to-severe reduction of LV function in all patients (mean 45±10%). A transmural area of high T2 signal in the mid and apical regions was visible in 113 (72%) patients matching the distribution of LV dysfunction. In 11 patients (5%), focal or patchy LGE was detected with a signal intensity lower than that typically observed in myocardial infarction or myocarditis (<5 SD above mean of normal myocardium in all patients). Of 89 TTC patients assessed using the Lake Louise Criteria, 56 (63%) were positive for acute myocardial inflammation. Follow-up CMR showed complete normalization of LV function (mean 67±8%) and inflammatory parameters in the absence of LGE in all patients.
Conclusions: In this largest CMR series to date in TTC patients, the main diagnostic criteria for TTC are: 1) Typical pattern of LV dysfunction; 2) Edema in the mid and apical myocardium 3) Absence of LGE >5 SD; 4) Myocardial inflammation values. Recovery of LV dysfunction, inflammatory parameters and LGE at CMR follow-up can be used to confirm the diagnosis retrospectively.
- © 2010 by American Heart Association, Inc.