Magnetic resonance reveals long-term sequelae of apical ballooning syndrome

Bellera, M. Neus; Ortiz, José T.; Caralt, M T; Pérez-Rodón, Jordi; Mercader, Jaume; Fernández-Gómez, Carlos; Paré, Carles; Heras, Magda

doi:10.1016/j.ijcard.2008.08.023

Cited by 14 publications

(5 citation statements)

References 32 publications

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“…This observation is in good agreement with a previous study by Sharkey et al, who reported that approximately 5% of TC patients showed delayed LV ejection fraction normalization up to 12 months. 31 Bellera et al recently reported that LGE was observed in 3 of 17 patients with apical ballooning syndrome on contrast-enhanced MRI performed at 11±9 months, 32 indicating the presence of irreversible myocardial damage in these patients. However, in our current study, all LGE lesions disappeared within 12 months after onset.…”

Section: Discussionmentioning

confidence: 94%

Prevalence and Signal Characteristics of Late Gadolinium Enhancement on Contrast-Enhanced Magnetic Resonance Imaging in Patients With Takotsubo Cardiomyopathy

Nakamori

Matsuoka

Onishi

et al. 2012

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp akotsubo cardiomyopathy (TC) is a cardiovascular event characterized by acute chest pain with ST-segment elevation and/or T-wave inversion, absence of substantial coronary arterial narrowing on angiography, and reversible systolic dysfunction with abnormal wall motion of the mid and distal left ventricle. 1-3 Cardiac magnetic resonance imaging (MRI) has emerged as a non-invasive imaging modality that permits assessment of myocardial infarction and edema, as well as left ventricular (LV) function. 4-6 In most of the previous studies that have evaluated MRI findings of TC, 7-12 the absence of late gadolinium enhancement (LGE) was considered to be an important finding to differentiate TC from acute myocardial infarction (AMI) in patients with acute chest pain. Recently, several reports indicated that TC may exhibit LGE in the acute phase. 13-16 In a recent multicenter study evaluating TC patients in Europe and the United States, LGE was detected in 9% of TC patients, by using a threshold of 3 standard deviations (SD) above the mean of remote normal myocardium to define the presence of LGE. 17 However, the signal intensity (SI) characteristics of LGE in TC were not well defined in comparison with AMI in those previous studies. In addition, limited data are currently available regarding the prevalence of LGE in TC patients in Japan. Accordingly, the purpose of our study was to determine the SI characteristics of LGE in patients with TC in comparison with AMI, and to evaluate the relationship between the presence of LGE and recovery of wall motion abnormality (WMA). Editorial p 814 MethodsPatients With TC All examinations were approved by the institution's board of medical ethics and clinical investigation and all subjects gave written informed consent. We enrolled 28 consecutive patients

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Section: Discussionmentioning

confidence: 94%

Prevalence and Signal Characteristics of Late Gadolinium Enhancement on Contrast-Enhanced Magnetic Resonance Imaging in Patients With Takotsubo Cardiomyopathy

Nakamori

Matsuoka

Onishi

et al. 2012

Circ J

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“…Especially the last finding may challenge the diagnosis of TTC. But from our perspective, all symptoms point to unidentified pathomechanisms and to a broader clinical spectrum of TTC [5, 13, 14, 48]. The chronic mental distress of our patient is another remarkable feature of our case.…”

Section: Resultsmentioning

confidence: 67%

“…In a subgroup of patients, cardiac MRI late enhancement may be present and last over time [12]. Late enhancement consistent with myocardial scarring has been reported sporadically and scars were not associated with adverse long term outcomes [5, 13]. The exact pathomechanisms of TTC have not been elucidated [14, 15].…”

Section: Introductionmentioning

confidence: 99%

Recurrent Tako-Tsubo cardiomyopathy (TTC) in a pre-menopausal woman: late sequelae of a traumatic event?

Hefner

Csef

Frantz

et al. 2015

BMC Cardiovasc Disord

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Background“Tako-Tsubo cardiomyopathy” (TTC) is a syndrome characterized by left ventricular (LV) wall motion abnormalities, usually without coronary artery disease, mimicking the diagnosis of acute coronary syndrome. It most often affects post-menopausal women and TTC tends to run a benign course with very low rates of recurrence, complications or mortality. The condition is also called “stress-induced cardiomyopathy” because acute physical or emotional stress appears to be frequently related to its onset. The pathogenic role of premorbid or comorbid psychiatric illnesses has been discussed controversially. For the first time, we present a case of fourfold recurrent TTC with severe complications in a pre-menopausal woman. Furthermore, a long history of flaring posttraumatic stress symptoms anteceded the first event.Case presentationA 43-year old, pre-menopausal Caucasian woman was hospitalized with symptoms of acute coronary syndrome. Clinical examination revealed hypokinetic wall motion in the apical ventricular region with no signs of coronary artery disease and diagnosis of TTC was established. She experienced recurrence three times within the following ten months, which led to thrombembolism and myocardial scarring among others. The circumstances of chronic distress were striking. 16 years ago she miscarried after having removed a myoma according to her doctor’s suggestion. Since then, she has suffered from symptoms of posttraumatic distress which peaked annually at the day of abortion. Chronic distress became even more pronounced after the premature birth of a daughter some years later. The first event of TTC occurred after a family dispute about parenting.ConclusionThis is the first case report of fourfold TTC in a pre-menopausal woman. From somatic perspectives, the course of the disease with recurrences and complications underlines the fact that TTC is not entirely benign. Furthermore, it is the first case report of long lasting symptoms of traumatic stress anteceding TTC. Close connections between adrenergic signaling and late onset of clinical stress symptoms are well known in the psychopathology of traumatization. Although larger clinical trials are needed to elucidate possible interactions of premorbid psychiatric illnesses and TTC, cardiologists should be vigilant especially in cases of recurrent TTC.

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“…Positive late gadolinium enhancement (LGE) may appear for three reasons: increased cardiomyocytes interstitial water content [70], collagen-1 fiber density [71] and the presence of contraction band necrosis [72,73]. There is evidence that microvascular dysfunction plays an important role in the pathogenesis of TTC, therefore the usefulness of quantitative perfusion CMR which is not practically used in TTC patients, for the evaluation of microvascular ischaemia has been reported [74]. Noteworhty that microvascular dysfunction was significantly more associated to apical TTC than the other types [75].…”

Section: Cardiac Imaging In Ttcmentioning

confidence: 99%

Takotsubo cardiomyopathy

Matta¹,

Delmas²,

Campelo-Parada³

et al. 2022

Rev. Cardiovasc. Med.

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Takotsubo cardiomyopathy (TTC) is a clinical condition of transient acute heart failure correlated to regional wall motion abnormalities extending beyond the distribution of a single epicardial coronary artery. It is classified into four major types: apical, basal, mid-ventricular and focal. Sympathetic nerve stimulation and catecholamine storm are the main players in the pathogenesis of TTC. The clinical course of disease is generally benign but it may end with life-threatening complications. Coronary angiography, left ventriculogram, transthoracic echocardiography and cardiac magnetic resonance imaging (CMR) are the main tools for making diagnosis. Except for critical cases with hemodynamic instability and/or complications, the overall management is limited to conventional heart failure therapy.

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Magnetic resonance reveals long-term sequelae of apical ballooning syndrome

Cited by 14 publications

References 32 publications

Prevalence and Signal Characteristics of Late Gadolinium Enhancement on Contrast-Enhanced Magnetic Resonance Imaging in Patients With Takotsubo Cardiomyopathy

Prevalence and Signal Characteristics of Late Gadolinium Enhancement on Contrast-Enhanced Magnetic Resonance Imaging in Patients With Takotsubo Cardiomyopathy

Recurrent Tako-Tsubo cardiomyopathy (TTC) in a pre-menopausal woman: late sequelae of a traumatic event?

Takotsubo cardiomyopathy

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