Abstract 17859: Tako-Tsubo Cardiomyopathy: a Slowly Resolving Pancarditis
Introduction: Tako-Tsubo cardiomyopathy (TTC) is characterized by predominantly apical, apparently transient, systolic left ventricular dysfunction. While the pathogenesis of TTC remains uncertain, an inflammatory response has been demonstrated within myocardium by biopsy and edema by T2-weighted cardiac Magnetic Resonance (cMR) imaging. We sought to determine (a) the extent and (b) the time-course of T2-detected myocardial oedema after acute presentation with TTC.
Methods: Twenty-two female patients [mean age 68.9 ± 11.6 (SD)] underwent cMR with T2-weighted SPIR imaging 3.0 ± 1.8 days after presentation with TTC; repeat scanning was performed at three months. Regional T2 intensity was determined in seven short axis sections from base to apex, with CV values of 6%. T2 intensity was corrected for background utilizing mean values from normal post-menopausal females (n=9).
Results: Segmental background-corrected T2 values at presentation (closed symbols) and three months (open symbols), compared via two-way ANOVA, differed between acute and 3-month data (F=4.55; p=0.043), gradient (F=9.71; p<0.0001), and region (F=9.17; p<0.0001; designated on the figure from base to apex, 1 though 7). At 3-months, T2 intensities remained substantially greater than control values.
Conclusion: (1) TTC-associated edema indicates the presence of a pancarditis with an acute base-to-apex gradient of inflammation. (2) At 3 months, there is residual T2 signal, without persistent regional heterogeneity.
- © 2010 by American Heart Association, Inc.