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Inflammation in takotsubo cardiomyopathy: insights from cardiovascular magnetic resonance imaging

  • Magnetic Resonance
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Abstract

Objective

Takotsubo cardiomyopathy (TTC) is an increasingly recognised acute cardiac syndrome, whose underlying pathophysiological mechanisms remain unknown. Inflammation might play a role as this has been shown in endomyocardial biopsies. The aim of this study was to assess inflammatory parameters in patients with TTC using a comprehensive cardiovascular magnetic resonance imaging (CMR) approach.

Methods

Thirty-seven patients with the suspected diagnosis of TTC underwent CMR. T2-weighted imaging to calculate the oedema ratio, T1-weighted imaging before and after contrast agent administration to calculate the global relative enhancement (gRE), and late gadolinium enhancement (LGE) imaging were performed.

Results

In 11 patients CMR revealed the diagnosis of myocardial infarction (n = 7; 19%) or myocarditis (n = 4; 11%) with typical patterns of LGE. In all other patients (n = 26; 70%), no LGE was detected consistent with the diagnosis of TTC. Of these, in 16 patients (62%) both inflammatory markers (oedema ratio and gRE) were elevated with concomitant pericardial effusion, indicating acute inflammation. Follow-up CMR after 3 months showed complete normalisation of left ventricular function and inflammatory parameters in the absence of LGE and pericardial effusion.

Conclusion

This CMR study provides further insights into the pathophysiological mechanisms in TTC, supporting the contribution of an inflammatory process in the acute setting.

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Authors and Affiliations

  1. Department of Internal Medicine/Cardiology, University of Leipzig—Heart Centre, Strümpellstr. 39, 04289, Leipzig, Germany

    Ingo Eitel, Mahdi Sareban, Gerhard Schuler & Holger Thiele

  2. Department of Diagnostic and Interventional Radiology, University of Leipzig—Heart Centre, Leipzig, Germany

    Christian Lücke, Matthias Grothoff & Matthias Gutberlet

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  1. Ingo Eitel
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  2. Christian Lücke
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  3. Matthias Grothoff
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  4. Mahdi Sareban
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  5. Gerhard Schuler
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  6. Holger Thiele
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  7. Matthias Gutberlet
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Correspondence to Ingo Eitel.

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Eitel, I., Lücke, C., Grothoff, M. et al. Inflammation in takotsubo cardiomyopathy: insights from cardiovascular magnetic resonance imaging. Eur Radiol 20, 422–431 (2010). https://doi.org/10.1007/s00330-009-1549-5

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  • DOI: https://doi.org/10.1007/s00330-009-1549-5

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