Multiparametric relaxometry by cardiac magnetic resonance imaging in Takotsubo cardiomyopathy

Extract

A 67-year-old female with a history of recent bereavement was admitted with acute-onset chest pain and global ST-segment changes. She underwent emergency coronary angiography, which demonstrated no flow-limiting coronary arterial disease.

Cardiovascular magnetic resonance (CMR) was performed on day 1 and included the following pulse sequences: cines, native-T₁ mapping (Modified Look Locker Inversion recovery) and T₂-weighted imaging, early and late gadolinium enhancement (LGE) imaging and 15-min post-contrast T₁-mapping.

Cine images showed akinesia of the mid-apical anterior and anteroseptal segments and the apex with preserved contractility at the base (see Supplementary data online, Video S1). T₂-weighted imaging demonstrated corresponding high signal suggestive of myocardial oedema (Panels 1a–c). Native-T₁ maps (Panels 2a–c, using cut-off of 1000 ms) and extra-cellular volume (ECV) maps (Panels 3a–c, using cut-off of 29%) demonstrated high native-T₁ and mildly raised ECV in the same segments. LGE imaging (Panels 4a–c) showed no evidence of infarction.

On the basis of the clinical history, coronary angiogram, and CMR findings, a diagnosis of Takotsubo cardiomyopathy (TC) was made. Although the abnormalities on CMR affected mainly the left anterior descending coronary artery territory, this pattern of injury has been described in TC.