Slowly resolving global myocardial inflammation/oedema in Tako-Tsubo cardiomyopathy: evidence from T2-weighted cardiac MRI. Issue 17 (11th July 2012)

• Record Type: Journal Article
• Authors: Neil, Christopher; Nguyen, Thanh Ha; Kucia, Angela; Crouch, Benjamin; Sverdlov, Aaron; Chirkov, Yuliy; Mahadavan, Gnanadevan; Selvanayagam, Joseph; Dawson, Dana; Beltrame, John; Zeitz, Christopher; Unger, Steven; Redpath, Thomas; Frenneaux, Michael; Horowitz, John
• Is Part Of: Heart. Volume 98:Issue 17(2012)
• Page Start: 1278
• Page End: 1284
• Publication Date: 2012-07-11
• Subjects: Tako-Tsubo cardiomyopathy -- oedema -- cardiovascular MRI -- N-terminal proBNP -- allied specialties -- psychology/psychiatry -- depression -- myocardial disease -- myocardial ischaemia and infarction (IHD) -- imaging and diagnostics -- heart failure -- endothelium -- basic science -- free radicals -- oxidative stress -- cardiac function -- tissue doppler -- cardiomyoplasty -- cardiac ultrasound -- coronary angiography -- exercise echocardiography -- cardiac remodelling -- CT scanning -- echocardiography-exercise -- syndrome x -- myocardial viability -- coronary artery disease -- gender -- coronary artery disease -- spasm -- coronary physiology -- coronary flow -- angina treatment -- microvascular -- MRI -- heart failure treatment -- hypertrophic cardiomyopathy -- endothelial function -- nitrites -- oxidative stress -- heart failure treatment -- cardiomyopathy hypertrophic; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heartjnl-2011-301481
• Languages: English
• ISSNs: 1355-6037

Abstract

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.