Cardiac magnetic resonance assessment of takotsubo cardiomyopathy

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

“…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. The above notwithstanding ECHO performed on admission before and/or after CAG, revealing SCAD, 6 could provide the first hints that TTS is occasionally associated with SCAD.…”

“…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 .…”

“…ECHO is not expected to provide direct information about the status of coronary arteries, but its association with cardiac computed angiography (CTA) and cardiac magnetic resonance imaging (cMRI) could provide many insights and key contributions in the differentiation between SCAD and TTS. 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.…”

Transient left ventricular outflow tract obstruction with systolic anterior motion of the mitral valve: A stunning cause

“…2 There is no way to differentiate between these three diagnostic scenarios in this case report. Perhaps a cardiac magnetic resonance (cMRI) revealing late gadolinium enhancement sequences in the subendocardial myocardial layer, indicative of increased fibrosis/scar, might support these two latter diagnostic possibilities, 3 although there is no absolute demarcation in separating TTS, from myocardial ischemic necrosis following a myocardial infarction. Moreover, the presence of fibrosis/scar in a cMRI is not incompatible with complete restoration of left ventricular function to normality.…”

Ventricular Septal Dissection/Perforation and Takotsubo Syndrome

“…It is not clear what the authors imply by their remarks about the pathological biopsy findings (“the ventricular septum showed fibrosis without inflammatory cell infiltration,” and “localized interstitial fibrosis and inflammatory cell infiltrates were revealed in the root of the papillary muscle”); do they implicitly refer to similarities or differences from the pathological findings in patients with acute myocardial infarction (AMI)? This has relevance to the current intense activity in differentiating TTS from myocarditis and AMI, employing cardiac magnetic resonance imaging (cMRI) with late gadolinium enhancement, for tissue characterization of fibrosis and scar . This patient did not have a cMRI, which would have added a dimension to this report.…”