Late gadolinium enhancement does occur in Tako-tsubo cardiomyopathy — a quantitative cardiac magnetic resonance and speckle tracking strain study

Gaikwad, Niranjan, Butler, Thomas, Maxwell, Ryan, Shaw, Elizabeth, Strugnell, Wendy E., Chan, Jonathan, Figtree, Gemma A., Slaughter, Richard E. and Hamilton-Craig, Christian (2016) Late gadolinium enhancement does occur in Tako-tsubo cardiomyopathy — a quantitative cardiac magnetic resonance and speckle tracking strain study. International Journal of Cardiology, 12 68-74. doi:10.1016/j.ijcha.2016.07.009


Author Gaikwad, Niranjan
Butler, Thomas
Maxwell, Ryan
Shaw, Elizabeth
Strugnell, Wendy E.
Chan, Jonathan
Figtree, Gemma A.
Slaughter, Richard E.
Hamilton-Craig, Christian
Title Late gadolinium enhancement does occur in Tako-tsubo cardiomyopathy — a quantitative cardiac magnetic resonance and speckle tracking strain study
Journal name International Journal of Cardiology   Check publisher's open access policy
ISSN 2352-9067
Publication date 2016-09-01
Sub-type Article (original research)
DOI 10.1016/j.ijcha.2016.07.009
Open Access Status DOI
Volume 12
Start page 68
End page 74
Total pages 7
Place of publication Amsterdam, Netherlands
Publisher Elsevier BV
Collection year 2017
Language eng
Abstract Late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR) has been recommended to distinguish Tako-tsubo cardiomyopathy (TTC) from either acute myocardial infarction or myocarditis.
Formatted abstract
Background: Late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR) has been recommended to distinguish Tako-tsubo cardiomyopathy (TTC) from either acute myocardial infarction or myocarditis.

Method: 44 consecutive patients with confirmed Mayo Clinic criteria for TTC underwent CMR imaging at 1.5 Tesla during the acute phase. 10 patients who had CMRI to exclude scar related ventricular tachycardia, and had negative studies, were used as negative controls. LGE was quantitated at two signal intensity thresholds (CircleCVi software) at > 2 and > 5 standard-deviations (SD) above reference myocardium, and compared to biomarkers.

Findings: Mean door-to-CMR time was 57 hours. 18 patients (41%) had LGE > 2 SD localized to the area of abnormal wall motion, representing 28.9 ± 11.2% LV mass. In 16 of these 18 patients (89%) LGE signal intensity was > 5 SD above normal myocardium, representing 12.1 ± 10% LV mass. LGE signal intensity was significantly greater in TTC than in matched controls (p < 0.05) but lower than in STEMI patients (p < 0.05). Mean troponin was significantly higher in LGE positive patients (2.5 ± 1.8 vs 4.4 ± 6.9, p = 0.001). Mean ejection fraction (EF) by CMR was 45% ± 8.7 in LGE-negative, and 40% ± 7.1 in LGE-positive patients (p = 0.37). Recovery of segmental function was confirmed at follow-up, mean EF was 59% in both groups.

Conclusion: LGE was present in 41% of cases of TTC, 89% of which had intense enhancement > 5 SD above normal myocardium. Presence of LGE was associated with worse myocardial injury in the acute setting, with no difference in recovery of function.
Keyword Cardiac magnetic resonance
Infarct quantitation
Late gadolinium enhancement
Speckle tracking strain echocardiography
Stress cardiomyopathy
Tako-tsubo
Q-Index Code C1

Document type: Journal Article
Sub-type: Article (original research)
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