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

Christopher Neil, T Nguyen, Angela Kucia, Benjamin Crouch, Aaron Sverdlov, Yuliy chirkov, Gnanadevan Mahadavan, Joseph Selvanayagam, Dana Dawson, John Beltrame, Chris Zeitz, Steven Unger, Thomas Redpath, Michael Frenneaux, John Horowitz

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    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.

    Original languageEnglish
    Pages (from-to)1278-1284
    Number of pages7
    JournalHeart
    Volume98
    Issue number17
    DOIs
    Publication statusPublished - 2012

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    Neil, C., Nguyen, T., Kucia, A., Crouch, B., Sverdlov, A., chirkov, Y., Mahadavan, G., Selvanayagam, J., Dawson, D., Beltrame, J., Zeitz, C., Unger, S., Redpath, T., Frenneaux, M., & Horowitz, J. (2012). Slowly resolving global myocardial inflammation/oedema in Tako-Tsubo cardiomyopathy: evidence from T2-weighted cardiac MRI. Heart, 98(17), 1278-1284. https://doi.org/10.1136/heartjnl-2011-301481