Abstract 13432: Clinical Significance of Early Gadolinium Enhancement for Detecting Myocardial Damage in Patients With Takotsubo Cardiomyopathy
Background: T2-weighted imaging (T2WI) on cardiovascular magnetic resonance (CMR) allows for identification of acute inflammation and myocardial edema. We have previously shown that early gadolinium enhancement (EGE) is an alternative technique for identifying myocardial edema in patients with Takotsubo cardiomyopathy (TCM). The present study investigates whether EGE can identify impaired myocardial regions in patients with TCM.
Methods: We studied 60 consecutive patients with TCM (7 males and 53 females, mean age 70±12 [SD] years) who underwent gadolinium (Gd)-enhanced CMR using a 1.5 T scanner to determine the myocardium to ventricular lumen signal intensity ratio (M/L ratio). CMR images were acquired 2, 5, 10, and 20 minutes after injection of gadolinium (0.15 mmol/kg body weight). The EGE phase was defined as 2 to 5 minutes after Gd administration. The inversion delay time was fixed at 300 msec. Follow-up cine CMR was also performed to evaluate myocardial wall motion recovery 14 and 30 days after the onset of TCM.
Results: EGE was detected in 43 patients (72%) (Figure, yellow arrows), and high signal intensity on T2WI was seen in 39 patients (65%) in the region with abnormal wall motion. The M/L ratio 5 minutes after Gd administration in impaired regions was significantly higher than at baseline (0.5±0.1 vs. 2.5±0.4, p<0.01). Furthermore, there was good agreement between regions with EGE and regions with high intensity signals on T2WI (r=0.79, p<0.01). There was only one (1.7%) patient with conventional late GE. Follow-up CMR demonstrated that recovery of regions with abnormal wall motion was delayed in EGE-positive patients compared with EGE-negative patients (28±5 vs.14±3 days, p<0.01).
Conclusion: In TCM, EGE could delineate a greater extent of myocardial damage that is associated with delayed recovery of wall motion abnormalities.
- © 2013 by American Heart Association, Inc.