The role of cardiovascular magnetic resonance in takotsubo syndrome

Abstract

Takotsubo syndrome (TS) is a transient form of left ventricular dysfunction associated with a distinctive contraction pattern in the absence of significant coronary artery disease triggered by stressful events. Several aspects of its clinical profile have been described but it still remains difficult to quickly establish the diagnosis at admission.Cardiovascular magnetic resonance (CMR) has achieved great improvements in the last years, which in turn has made this imaging technology more attractive in the diagnosis and evaluation of TS. With its superior tissue resolution and dynamic imaging capabilities, CMR is currently the most useful imaging technique in this setting.In this review, we propose to comprehensively define the role of CMR in the evaluation of patients with TS and to summarize a set of criteria suitable for diagnostic decision making in this clinical setting.Electronic supplementary materialThe online version of this article (doi:10.1186/s12968-016-0279-5) contains supplementary material, which is available to authorized users.

Imaging of Nonischemic Cardiomyopathy

“…Typically, LGE images do not show focal lesions that my otherwise be associated with acute myocardial infarction. However, LGE is infrequently reported in less than 10% of cases [9].…”

Antecedent cancer in Takotsubo syndrome predicts both cardiovascular and long-term mortality

“…Screening for TTS was performed routinely on patients admitted to 3 tertiary referral hospitals in Adelaide, South Australia. The diagnosis of TTS was based upon modified Mayo Clinic Criteria [15], essentially consisting of presence of evidence of acute left ventricle (LV) regional systolic dysfunction, together with exclusion of acute myocardial infarction (AMI) by coronary angiography and/or cardiovascular magnetic resonance (CMR) [16]. The severity of acute attacks was quantitated via: (1) severity of LV dysfunction [acute LV ejection fraction (LVEF), as measured by transthoracic echocardiography], (2) clinical measures of hemodynamic changes (lowest systolic BP within the first 48 h, presence of shock), (3) extent of myocardial injury (peak troponin T concentrations), (4) inflammatory changes [peak concentrations of high sensitive C-reactive protein (hs-CRP) and N-terminal pro B-type natriuretic peptide (NT-proBNP)], and (5) markers of catecholamine release (normetanephrine and metanephrine concentrations).…”

Could echocardiography determine whether spontaneous coronary dissection is occasionally associated with Takotsubo syndrome?

“…cMRI can provide details of the structure of all 4 cardiac chambers, the absence or presence of LV hypertrophy and apical "pseudohypertrophy" found transiently in TTS, 18,19 and the absence or presence of myocardial fibrosis and myocardial scar, and its location, important for the differentiation between SCAD and TTS. 6,14,16,17 Also, cMRI with late gadolinium enhancement (LGE) can detect myocardial scar, consequent to occasional prolonged myocardial ischemia in patients with SCAD, or persisting scar in patients with ACS and STEMI or myocarditis, useful in differentiation among ischemic pathology, myocarditis, and TTS. 6,17 Both, clinicians and researchers, encountering patients with SCAD and/or TTS, should adopt the mindset of interpreting images from such patients in concert, exemplified by the analysis provided in Figures 1 and 2; multidisciplinary approach to imaging will aid in diagnosing TTS, SCAD, and occasional cases when both are present, 6 and eventually ascertain which preceded (ie, caused) the other.…”

“…CTA can provide details about the coronary arteries, their courses, the absence or presence of calcification, and stenotic lesions, myocardial bridging, SCAD, vessel aneurismal dilatations, as the ones found in fibromuscular dysplasia, and many other particulars, important in the diagnosis of SCAD and TTS. cMRI can provide details of the structure of all 4 cardiac chambers, the absence or presence of LV hypertrophy and apical “pseudohypertrophy” found transiently in TTS, and the absence or presence of myocardial fibrosis and myocardial scar, and its location, important for the differentiation between SCAD and TTS . Also, cMRI with late gadolinium enhancement (LGE) can detect myocardial scar, consequent to occasional prolonged myocardial ischemia in patients with SCAD, or persisting scar in patients with ACS and STEMI or myocarditis, useful in differentiation among ischemic pathology, myocarditis, and TTS .…”