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Type: Journal article
Title: Slowly resolving global myocardial inflammation/oedema in Tako-Tsubo cardiomyopathy: evidence from T2-weighted cardiac MRI
Author: Neil, C.
Nguyen, T.
Kucia, A.
Crouch, B.
Sverdlov, A.
Chirkov, Y.
Mahadevan, G.
Selvanayagam, J.
Dawson, D.
Beltrame, J.
Zeitz, C.
Unger, S.
Redpath, T.
Frenneaux, M.
Horowitz, J.
Citation: Heart, 2012; 98(17):1278-1284
Publisher: British Med Journal Publ Group
Issue Date: 2012
ISSN: 1355-6037
Statement of
Christopher Neil, Thanh Ha Nguyen, Angela Kucia, Benjamin Crouch, Aaron Sverdlov, Yuliy Chirkov, Gnanadevan Mahadavan, Joseph Selvanayagam, Dana Dawson, John Beltrame, Christopher Zeitz, Steven Unger, Thomas Redpath, Michael Frenneaux and John Horowitz
Abstract: OBJECTIVE: Tako-Tsubo cardiomyopathy (TTC) is associated with regional left ventricular dysfunction, independent of the presence of fixed coronary artery disease. Previous studies have used T2-weighted cardiac MRI to demonstrate the presence of periapical oedema. The authors sought to determine the distribution, resolution and correlates of oedema in TTC. PATIENTS: 32 patients with TTC were evaluated at a median of 2 days after presentation, along with 10 age-matched female controls. Extent of oedema was quantified both regionally and globally; scanning was repeated in patients with TTC after 3 months. Correlations were sought between oedema and the extent of hypokinesis, catecholamine release, release of N-terminal prohormone of B-type natriuretic peptide (NT-proBNP), and markers of systemic inflammatory activation (high-sensitivity C-reactive protein and platelet response to nitric oxide). RESULTS: In the acute phase of TTC, T2-weighted signal intensity was greater at the apex than at the base (p<0.0001) but was nevertheless significantly elevated at the base (p<0.0001), relative to control values. Over 3 months, T2-weighted signal decreased substantially, but remained abnormally elevated (p<0.02). The regional extent of oedema correlated inversely with radial myocardial strain (except at the apex). There were also direct correlations between global T2-weighted signal and (1) plasma normetanephrine (r=0.39, p=0.04) and (2) peak NT-proBNP (r=0.39, p=0.03), but not with systemic inflammatory markers. CONCLUSIONS: 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.
Keywords: Myocardium
Natriuretic Peptide, Brain
Peptide Fragments
C-Reactive Protein
Magnetic Resonance Imaging, Cine
Case-Control Studies
Aged, 80 and over
Middle Aged
Takotsubo Cardiomyopathy
Rights: Copyright © 2012 BMJ Publishing Group Ltd & British Cardiovascular Society All rights reserved.
DOI: 10.1136/heartjnl-2011-301481
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