Cardiovascular magnetic resonance T2 signal abnormalities in left ventricular ballooning syndrome

Joshi, S.; Chao, Tania; Herzka, Daniel A.; Zeman, Peter; Cooper, Howard A.; Lindsay, Joseph; Fuisz, Anthon

doi:10.1007/s10554-009-9515-5

Cited by 28 publications

(19 citation statements)

References 30 publications

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“…25 Furthermore, this modality provides information about the myocardium showing RWMA. 25, 26 The T2-weighted sequence usually reveals high signal intensity suggesting myocardial edema. Delayed enhancement with gadolinium, which suggests irreversible myocardial injury in AMI or myocarditis, is almost never detected in takotsubo cardiomyopathy.…”

Section: Cardiac Imagingmentioning

confidence: 99%

Clinical Management of Takotsubo Cardiomyopathy

Kurisu

Kihara

2014

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp stress such as asthma attack or non-cardiac surgery have been identified in previous cases. 3 These stressors are common events that anyone may experience. Men account for a minority of cases; reports range from 4% to 13%. 6-8 In men, physical stress rather than emotional stress is much more associated with the occurrence. 7,8 ElectrocardiographyCommon abnormalities on the initial ECG are ST-segment elevation, negative T wave and subsequent QT interval prolongation (Figure 2). 3-5,9-11 There is a significant variability in frequency because these ECG changes are time-dependent. 12, 13 The typical time course of the ECG is as follows. 12 ST-segment elevation usually occurs shortly after onset. Negative T wave deepens progressively to its first negative peak, which occurs at approximately 3 days. The negative T wave becomes shallow for several days and then deepens, the second negative peak occurring at approximately 2 weeks. QT interval becomes prolonged progressively as the negative T wave deepens. These ECG changes are found in takotsubo cardiomyopathy as well as AMI, and the differential diagnosis is clinically important for appropriate management. Ogura et al reported that the absence of reciprocal changes, the absence of abnormal Q wave and the sum of ST-segment elevation in leads V4-6 more than the sum of ST-segment elevation in leads V1-3 identified takotsubo cardiomyopathy with a high sensitivity and specificity. 14 Kosuge et al recently reported that the combination of ST-segment depression in lead aVR and no STsegment elevation in lead V1, or the combination of positive T wave in lead aVR and no negative T wave in lead aVR, was more useful in identifying takotsubo cardiomyopathy. 15,16 EchocardiographyEchocardiography plays a central role in the diagnosis of takotsubo cardiomyopathy. Typically, RWMA is found in the apical to mid segments of the left ventricle, extending beyond a single coronary territory. Relative compensatory hypercontractility is often found in the basal segment. Other patterns akotsubo cardiomyopathy is an acute cardiac syndrome mimicking acute myocardial infarction (AMI), and is characterized by chest symptoms, electrocardiographic (ECG) changes and reversible regional wall motion abnormality (RWMA) in the apical to mid segments of the left ventricle. 1-5 In contrast to AMI, takotsubo cardiomyopathy exhibits RWMA independent of acute plaque rupture or myocardial ischemia with coronary atherosclerosis during the early stage. RWMA occurs in the apical to mid segments of the left ventricle, extending beyond a single coronary territory (Figure 1), and it usually resolves spontaneously within a matter of days to a few weeks.Takotsubo cardiomyopathy was first reported by Sato et al at Hiroshima City Hospital in 1990, 1-3 since when it has become increasingly recognized worldwide. Several mechanisms, including multivessel coronary artery spasm, coronary microvascular dysfunction or catecholami...

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Section: Cardiac Imagingmentioning

confidence: 99%

Clinical Management of Takotsubo Cardiomyopathy

Kurisu

Kihara

2014

Circ J

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“…Interestingly, Joshi et al [16] reported that patients who had follow-up MR imaging at 2-3 weeks showed normalization of the wall motion abnormalities associated with a significant reduction in the T2 signal intensity. That finding is consistent with the MRI result of this current case.…”

Section: Discussionmentioning

confidence: 99%

A case of transient left ventricular apical ballooning syndrome in a child: clinical features and imaging findings

Lee

Choi

et al. 2010

Int J Cardiovasc Imaging

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Transient left ventricular apical ballooning syndrome (TLVABS) is an acute cardiac disease that is characterized by transient left ventricular systolic dysfunction involving the apical region. The symptoms and electrocardiographic changes of TLVABS mimic those observed in acute myocardial infarction while obstructive coronary arterial lesions are not seen in patients with TLVABS. TLVABS usually occurs in elderly women after physical or emotional stress. However, it is very rare in children and so it not well known to pediatricians. Accordingly, TLVABS in children can be misdiagnosed as myocarditis or cardiomyopathy. We report here on a case of child who showed the typical findings of TLVABS in association with pericarditis. He presented with dyspnea and pericardial effusion, which required pericardiocentesis. After pericardiocentesis, he showed the typical echocardiographic and electrocardiographic findings of TLVABS. The MRI findings at 14 days after the initial symptoms showed normal coronary arteries and normal left ventricular function without any wall motion abnormalities. In addition, no delayed hyper enhancement was found on delayed-enhanced (DE)-MRI. We also reviewed the other reported cases of TLVABS in patients who were under the age of 40.

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“…Elevated T2-signal consistent with myocardial edema is seen in patients with takotsubo cardiomyopathy. T2 signal is highest in myocardium with the most impaired function and resolves over time (21)(22). Myocardial edema on T2-STIR sequence is also a hallmark of ischemic myocardium prior to irreversible myocardial injury (23).…”

Section: Tissue Characterization -Myocardial Edema On T2-weighted Imagesmentioning

confidence: 99%

Role of Advanced Cardiac Magnetic Resonance Imaging in Atypical Cardiomyopathies such as Stress-Induced Cardiomyopathie and Left-Ventricular Non-Compaction Cardiomyopathy

Strohm¹,

Shehab²,

Qureshi³

2012

Cardiomyopathies - From Basic Research to Clinical Management

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Cardiovascular magnetic resonance T2 signal abnormalities in left ventricular ballooning syndrome

Cited by 28 publications

References 30 publications

Clinical Management of Takotsubo Cardiomyopathy

Clinical Management of Takotsubo Cardiomyopathy

A case of transient left ventricular apical ballooning syndrome in a child: clinical features and imaging findings

Role of Advanced Cardiac Magnetic Resonance Imaging in Atypical Cardiomyopathies such as Stress-Induced Cardiomyopathie and Left-Ventricular Non-Compaction Cardiomyopathy

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