Abstract 13466: Assessment of Myocardial and Microvascular Injury of Takotsubo cardiomyopathy and ST-elevation Myocardial Infarction by Cardiac Magnetic Resonance Imaging
Background: Takotsubo cardiomyopathy (TC) is a novel cardiac condition characterized by distinctive regional left ventricular (LV) systolic dysfunction. Although acute LV systolic dysfunction as well as ST-elevation on electrocardiogram of TC mimics anterior ST-elevation myocardial infarction (STEMI), clinical course of TC is generally far more uncomplicated than anterior STEMI. Cardiac magnetic resonance (CMR) imaging provides an opportunity to assess myocardial and microvascular injury.
Method: This study consisted of 34 patients with TC and 20 patients with a first anterior STEMI. All patients underwent emergency coronary angiography and left ventriculography within 12 hours after symptom onset. Primary coronary intervention was successful in all 20 STEMI patients. CMR was performed before discharge. Severe myocardial and microvascular damage was detected by >50% of the extent of late gadlinium enhancement (LGE) and microvascular obstruction (MVO), respectively.
Results: There was no significant difference in LV ejection fraction (44±6% vs 42±8%, p=ns) and LV end-diastolic pressure (16±6mmHg vs 18±7mmHg, p=ns) between TC and STEMI. Peak creatine kinase was significantly lower in TC (CK; 584±1283 IU/l vs 4069±3255 IU/l, p<0.001). The incidence of >50% of the extent of LGE was significantly lower in TC than STEMI (0.03% vs 47%, p<0.001). None of TC patients had MVO, whereas MVO was found in 12% of STEMI patients (p<0.001).
Conclusion: Dspite of similar acute LV contraction and hemodynamics, TC had less myocardial and microvascular injury than STEMI. Such myocardial and microvascular integrity may be contributable to uncomplicated clinical course of patients with TC.
- © 2012 by American Heart Association, Inc.