Clinical Characteristics and Cardiovascular Magnetic Resonance Findings in Stress (Takotsubo) Cardiomyopathy

Eitel, Ingo; Knobelsdorff‐Brenkenhoff, Florian von; Bernhardt, Peter; Carbone, Iacopo; Muellerleile, Kai; Aldrovandi, Annachiara; Francone, Marco; Desch, Steffen; Gutberlet, Matthais; Strohm, Oliver; Schuler, Gerhard; Schulz‐Menger, Jeanette; Thiele, Holger; Friedrich, Matthias G.

doi:10.1097/sa.0b013e31825c20ae

Cited by 80 publications

(102 citation statements)

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“…This is the first study to examine the architectural recovery of the LV myocardium after a takotsubo event, using contrast-enhanced CMR. The increased LV mass 24 is presumably a reflection of the significant myocardial edema seen in the myocardium during the acute stage, previously reported by us and others 7,21,25 . There is extensive evidence that pre-contrast T1 mapping is reflective of edema, previously provided from our group 26 and by others [27][28][29] .…”

Section: Current Results In Context Of Previous Literaturementioning

confidence: 85%

Alterations in Cardiac Deformation, Timing of Contraction and Relaxation, and Early Myocardial Fibrosis Accompany the Apparent Recovery of Acute Stress-Induced (Takotsubo) Cardiomyopathy: An End to the Concept of Transience

Schwarz

Ahearn

Srinivasan

et al. 2017

Journal of the American Society of Echocardiography

104

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Background: Takotsubo syndrome is an increasingly recognized cause of chest pain and occasionally of cardiogenic shock. Despite rapid improvement of the Left Ventricular Ejection Fraction (LV EF), recent registry data raises concerns about long term prognosis. We hypothesized that restoration of normal EF after acute tako-tsubo is not equivalent to full functional recovery. Methods: We prospectively recruited 52 takotsubo patients [according to the Mayo criteria plus cardiac magnetic resonance imaging (CMR) to exclude myocardial infarction] and 44 healthy controls of the same age, gender and cardiovascular co-morbidity distribution. We focused the investigation on takotsubo patients presenting with ST-elevation type ECG or malignant arrhythmias and with LV apical ballooning variant and examined a 4 months recovery end-point. Patients underwent Echocardiography assessment of LV myocardial deformation (Global longitudinal, radial and circumferential strain, LV twist, torsion, untwist, time to peak twist and untwist) and assessment of LV myocardial structure by pre and post contrast-enhanced CMR by T1 mapping acutely and at 4 months follow-up. Controls had a single time-point investigation. Data were analyzed using paired or unpaired tests, as appropriate for their distribution and corrected for multiple comparisons. Results: The patients' mean age was 66 years (range 28-87) and 92% were women. All abnormal echocardiographic indices observed acutely in takotsubo patients improved (but not necessarily normalized) at followup. Significant mechano-temporal alterations characterizing both systole (global longitudinal strain, apical circumferential strain, both p<0.01; left ventricular twist, twist rate and torsion, all p<0.0001) and diastole (untwist rate and time to peak untwisting, all p<0.001) persisted at 4 months follow-up when compared with controls, despite normalization of LV ejection fraction and volumes. Whilst native T1 (which demonstrates edema) normalized at 4 months follow-up only in segments contracting normally during the acute phase [T1=1180± 40.6ms (normally contracting, p=0.2 vs control values of 1189±16 ms) and 1208± 60.3 ms (dysfunctional segments, p<0.05 vs control)], the extracellular volume fraction (ECV, which demonstrates diffuse fibrosis) remained significantly abnormal in all LV segments (whether normally contracting, 0.328±0.043, p<0.001 or ballooning during acute presentation, 0.320±0.044, p<0.001, both vs control values of 0.273±0.045). Conclusion: In patients with the most clinically severe spectrum of takotsubo cardiomyopathy, regional LV systolic and diastolic deformation abnormalities persist beyond the acute event, despite normalization of global LV EF and size. In addition, although myocardial edema partly subsides, a process of global microscopic fibrosis develops in its place, detected as early as 4 months.Suggested Reviewers:Opposed Reviewers: 1 24 th March, 2017 Dear Dr Pearlman, Thank you once again for your comments and those of the associate editors. I think it i...

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Section: Current Results In Context Of Previous Literaturementioning

confidence: 85%

Alterations in Cardiac Deformation, Timing of Contraction and Relaxation, and Early Myocardial Fibrosis Accompany the Apparent Recovery of Acute Stress-Induced (Takotsubo) Cardiomyopathy: An End to the Concept of Transience

Schwarz

Ahearn

Srinivasan

et al. 2017

Journal of the American Society of Echocardiography

104

View full text Add to dashboard Cite

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“…In our case, we believe that the following factors contributed to the development of DiSC in our patient. First, patient's age, female gender and psychiatric conditions certainly predisposed her for stress cardiomyopathy (10). Second, smoking is known to increase the risk of coronary vasospasms and microvascular dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Mid-ventricular variant of dobutamine-induced stress cardiomyopathy

2015

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Introduction: Dobutamine stress testing is a commonly used modality in detecting and estimating the prognosis in coronary artery disease (CAD). Although it is well tolerated by most patients, adverse events have been reported. Rarely, transient wall motion abnormalities can occur in the absence of obstructive CAD to suggest stress cardiomyopathy. Conclusions:The mechanism of mid-variant of Dobutamine-induced stress cardiomyopathy remains unclear. We think that multiple mechanisms are involved and this risk should be considered in patients with comorbid psychiatric conditions and with use of centrally acting stimulants.

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“…On contrary, focal or patchy LGE was detected in 9 % of enrolled subjects. In addition, one-third of patients demonstrated pleural and pericardial effusion particularly those with biventricular ballooning and evidence of myocardial inflammation [20]. During follow-up, four patients died.…”

Section: Cmr Findings In Tcmmentioning

confidence: 99%

TakoTsubo cardiomyopathy: unravelling the malignant consequences of a benign disease with cardiac magnetic resonance

2015

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TakoTsubo cardiomyopathy (TCM) is a unique type of reversible cardiomyopathy that is precipitated by a stressful emotional or physical event. The increasing incidence is due to the greater use of emergency coronary angiography, newer cardiac biomarkers together with more sensitive cardiac imaging techniques. Few case reports have documented how TCM can present with malignant arrhythmias such as torsades de pointes caused by the repolarisation abnormalities or QTc prolongation. Although TCM is usually considered a benign reversible condition, its associated arrhythmic risk is increasingly recognised. TCM often presents as an acute coronary syndrome with unobstructed coronary arteries at angiography. In this patient population, cardiac magnetic resonance (CMR) is a useful tool to establish a differential diagnosis, discriminating TCM from acute myocarditis and myocardial infarction with spontaneous recanalisation. CMR is becoming a promising new diagnostic modality in risk stratifying patients with potential higher arrhythmic risk.

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Clinical Characteristics and Cardiovascular Magnetic Resonance Findings in Stress (Takotsubo) Cardiomyopathy

Cited by 80 publications

References 0 publications

Alterations in Cardiac Deformation, Timing of Contraction and Relaxation, and Early Myocardial Fibrosis Accompany the Apparent Recovery of Acute Stress-Induced (Takotsubo) Cardiomyopathy: An End to the Concept of Transience

Alterations in Cardiac Deformation, Timing of Contraction and Relaxation, and Early Myocardial Fibrosis Accompany the Apparent Recovery of Acute Stress-Induced (Takotsubo) Cardiomyopathy: An End to the Concept of Transience

Mid-ventricular variant of dobutamine-induced stress cardiomyopathy

TakoTsubo cardiomyopathy: unravelling the malignant consequences of a benign disease with cardiac magnetic resonance

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