Slowly resolving global myocardial inflammation/oedema in Tako-Tsubo cardiomyopathy: evidence from T2-weighted cardiac MRI

Abstract

TTC is associated with slowly resolving global myocardial oedema, the acute extent of which correlates with regional contractile disturbance and acute release of both catecholamines and NT-proBNP.

Relation of Delayed Recovery of Myocardial Function After Takotsubo Cardiomyopathy to Subsequent Quality of Life

“…However, only the differences in GLS at 3 months were statistically significant (p=0.003) (Figure 1). GLS at 3 months was not significantly correlated with any indices of the acute TTC episode (plasma normetanephrine levels, troponin T, peak NT-proBNP levels, echo-derived 7 WMSI or extent of myocardial oedema on CMR) 12 . Correlations were also sought between markers of residual inflammation at 3 months and simultaneous GLS.…”

“…LVEF, left ventricular end-systolic volume index (LVESVi) and end-diastolic volume index (LVEDVi) (corrected to body surface area of individual subjects) were calculated utilizing Simpson's biplane method. The wall motion score index (WMSI) was determined as previously described 12 .…”

“…Cardiovascular magnetic resonance imaging (CMR) imaging was performed both acutely and after 3 months in order to quantitate myocardial oedema via integrated estimates of T2-weighted signal intensity (T2 SI) within the entire left ventricle, as previously described 12 .…”

“…However, recent clinical studies report persistence of symptoms well beyond this 10 , while myocardial inflammation persists on LV biopsy 11 and myocardial edema on MRI 12 3 months after acute attacks. Similarly, the associated (inflammatory) release of BNP/NT-proBNP persists for at least that duration 13 .…”

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

“…In view of these findings, Rolf et al [23] performed multiple endomyocardial biopsies in sites with and without LGE showing a significantly higher extracellular matrix containing collagen-1 in LGE areas. In another study, Neil et al [24] found increased T2-weighted signal intensity particularly at the apical cavity in all TCM patients that persisted after 3 months and was inversely related to myocardial strain. In accordance with the above-mentioned data, myocardial oedema on CMR is the only recognised feature in TCM, reflecting acute inflammation and myocardial injury [25].…”