Abstract 19251: In Tako-Tsubo Cardiomyopathy the Severity of Left Ventricular Dysfunction is Strongly Correlated With the Extent of Myocardial Edema Detected by Cardiac Magnetic Resonance.
Purpose: Myocardial edema (ME) has been demonstrated in tako-tsubo cardiomyopathy (TTC) by cardiac magnetic resonance (CMR) but its characteristics and correlation with the severity of left ventricular (LV) dysfunction had not been as yet defined. The purpose of the study was to assess the extent of ME and its relation to LV dysfunction in patients (pts) with TTC studied with CMR during the acute phase and after 1 month.
Methods: 17 pts, all women, aged 61±15 yrs, with TTC (11 apical and 6 midventricular) underwent CMR at a mean of 3±2 days from admission and after 1 month. Peak Troponin I was 3.4±2 ng/ml. ME was defined as a hyperenhanced signal (a signal intensity > 2 SD compared to normal myocardium) on triple inversion recovery T2-weighted images. Presence and extent of ME was evaluated semiquantitatively (0= no ME, 1= ME) and quantitatively (mass of ME, grams) on a short axis 16-segment LV model. Delayed enhancement (DE) after gadolinium injection was used to assess the presence of myocardial necrosis or fibrosis; LV end-diastolic (LVEDV) and end-systolic volumes (LVESV), ejection fraction (EF), wall motion score index (WMSI) and diastolic thickness on a 16-segment (sgs) model were assessed by ecg-gated cine steady state sequences in short axis.
Results: During acute phase mean EF was 43±9%, LVEDV and LVESV 123±27 and 69±22 ml respectively. No patients showed DE. ME was present in 91/138 dysfunctional vs 7/134 normal sgs (66% vs 5%, p<.001). Mass of ME was 27±18 grams, 41±26 % of the mass of LV. Both the mass of ME and the number of sgs with ME were significantly correlated with LVEF (r = .88, p <.0001 and r =.78, p =.0007) and with WMSI (r =.82, p =.0001 and r =.73, p=.0018). No significant correlation was found between ME and LVEDV, LVESV and diastolic sg thickness. At 1 month control CMR ME resolved in all 15 pts studied and FE improved from 43±9% to 62±7%(p=.0001).
Conclusion: The extensive ME observed in the acute phase of TTC is strongly correlated with the severity of LV dysfunction and its distribution corresponds to the dysfunctional sgs. Resolution of ME at 1 month from acute event is associated with recovery of LV function. Thus, ME appears to be a major determinant of myocardial stunning observed in TTC.
- © 2010 by American Heart Association, Inc.