心脏淀粉样变患者的心电图和心脏超声特点

目的 总结心内膜心肌活检(EMB)证实原发型心脏淀粉样变(CA)患者的心电图和心脏超声特点,为临床医师能够早期识别和诊断CA提供帮助.方法 自2006年9月至2009年10月收治临床怀疑CA患者共20例(其中男性7例),平均年龄(50±12)岁,进行EMB检查.11例(55%)患者诊断为CA,血清和(或)尿检查示游离单克隆轻链(λ)明显升高,确诊为原发型CA.分析该11例心电图和心脏超声的特点.结果 心电图分析发现,11例患者的6个肢导联电压均较低,均值为0.33～0.51 mV,其中肢导联低电压和假性梗死波形发生率均为45%.心脏超声检查结果分析发现,11例患者室壁呈向心性增厚和左心室腔容积正常,绝大多数患者可见左心房扩大(10例,91%)、心肌内可见颗粒样强回声(9例,82%)、中至大量心包积液(7例,64%)以及左心室收缩功能受损(8例,73%).结论 对于临床原因不明的心力衰竭,心脏超声示向心性肥厚且左心室腔容积不大,伴心肌内颗粒样强回声或心包积液,而心电图示肢导联低电压或假性梗死波形者,高度疑似原发型CA的可能性,应进一步行EMB和血清(尿)生化检查,以便早期明确诊断和及时治疗.     

磁共振成像在心内膜心肌活检阴性心肌炎患者中的诊断价值:回顾性病例系列研究

目的分析临床诊断心肌炎但心内膜心肌活检(EMB)阴性患者的心脏磁共振(CMR)表现,探讨CMR在此类患者中的诊断价值。方法该研究为回顾性分析。纳入符合2013年欧洲心脏病学会(ESC)心肌炎临床诊断标准,但EMB阴性的患者14例。所有患者均行CMR检查,通过黑血序列、电影序列、T2W-STIR序列及钆对比剂延迟增强(LGE)序列,评价心脏的形态学、功能学、组织学改变。结果该研究共纳入14例符合临床诊断标准的心肌炎患者,男10例,女4例,年龄为(25.6±13.2)岁,症状发作至行CMR检查时间间隔为21(13,60)d,症状发作距离EMB检查时间为19(9,40)d。CMR阳性患者13例,表现为心肌水肿、纤维化、射血分数减低、心包积液或心腔增大等。14例患者中共9例患者存在CMR形态和/或功能异常,其中左心房增大1例,左心室增大1例,右心室增大3例,左心室收缩末期容积指数超过正常范围4例,左心室射血分数<50%3例,右心室射血分数<40%5例,心包积液深度>3 mm 3例。14例患者中,有11例存在组织学改变,其中6例患者的T2比值≥2;LGE阳性10例(10/14),最常见的强化模式为左心室侧壁心外膜下和/或室间隔肌壁间(9例),另外左心室壁广泛心内膜下强化2例,无右心室壁强化。结论CMR能够在体评估心脏形态、功能及组织学改变,对于EMB阴性的心肌炎患者,CMR具有良好的补充诊断价值。     

心脏淀粉样变的心脏超声及心电图特点

目的：分析心脏淀粉样变患者的心脏超声及心电图特点,为临床医师早期识别和诊断心脏淀粉样变性提供帮助。方法：2003年7月～2011年10月我院结合临床及病理检查确诊心脏淀粉样变性患者20例,回顾性分析其超声心动图和心电图特点。结果：心脏超声检查所见：20例患者均表现室间隔[（15．67±3．60）mm]及左心室后壁向心性增厚[（15．73±3．54）mm]而左心室容积正常;所有患者均存在舒张功能不全;多数患者有左心房增大（19例,95％）,心内膜下心肌有颗粒样反光增强（17例,85％）,出现中一大量心包积液（11例,55％）。心电图表现为：20例患者心电图肢体导联的电压均较低,肢体导联低电压和假性梗死Q波的发生率分别为55％和45％。结论：不明原因心力衰竭的患者,如果心脏超声示心室肌肥厚且心室容积正常,伴心内膜下心肌内有颗粒样反光增强,而心电图又表现为肢体导联低电压或非梗死性Q波时,应考虑心脏淀粉样变性的可能性。应进一步行病理活检等检查,以利于早期诊断和治疗。     

心肌淀粉样变性的临床特点

目的　心肌淀粉样变性 ( cardiac amyloidosis CAL)是临床上相对少见的疾病 ,对其临床特点认识不足。本文分析CAL患者的临床特征 ,为正确诊断疾病奠定基础。方法　对近 2年来确诊为 CAL患者的临床、心电图、超声心动图和病理学特点进行了分析。结果　 3例患者确诊为 CAL。患者为老年 ( x=70岁 ) ,临床表现为肾病综合征 ( 3例 )和充血性心力衰竭 ( 2例 )。心电图显示肢体导联低电压 ( 3例 ) ,胸前、肢体导联异常 Q波 ( 3例 )。心肌电压和心肌团块比值下降。超声心动图显示左心室后壁和室间隔增厚 ( 3例 ) ;左心室舒张内径减小 ( 2例 ) ;左心房增大 ( 3例 ) ;E/ A比值倒置 ;心内膜闪耀的颗粒样物质 ( 1例 ) ;心包积液 ( 2例 ) ;左心室收缩功能正常 ( 3例 )。肾脏病理显示基底膜、小动脉大量微细纤维淀粉样物质沉积。结论　老年充血性心力衰竭、心脏舒张功能受损同时合并肾病综合征等提示 CAL的可能。当心脏外病理确诊为淀粉样变性后 ,心电图和超声心动图的特异改变可帮助确诊 CAL     

暴发性心肌炎的心脏磁共振延迟强化特征分析

目的 探讨暴发性心肌炎的心脏磁共振(CMR)延迟强化(LGE)特征.方法 选择2013年5月至2018年12月金华市中心医院临床诊断为急性心肌炎,CMR增强检查提示LGE为阳性的患者45例,其中暴发性心肌炎9例,非暴发性心肌炎36例.比较两组患者临床资料、左心室结构和功能参数及CMR LGE特征.结果 暴发性心肌炎组患...     

心脏CT检查对肥厚型心肌病合并冠心病患者的诊断价值

目的:评估心脏CT检查在诊断肥厚性心肌病(hypertrophic cardiomyopathy,HCM)可疑合并冠心病患者中的价值。方法:60例患者入组本研究。心脏CT检查包括冠状动脉CT血管造影(CT angiography,CCTA)和延迟强化检查。以冠状动脉造影(coronary angiography,CA)和心脏磁共振检查(cardiovascular magnetic resonance,CMR)作为参考标准,分别检测CCTA和延迟强化检查在评估冠状动脉狭窄程度、左心室舒张末期室壁厚度、心功能和心肌纤维化的诊断准确性。结果:与CA比较,CCTA在检测冠状动脉狭窄程度方面的敏感性、特异性、阳性预测值及阴性预测值分别为100%、94.4%、92.3%及100%。在检测左心室舒张末期室壁厚度、心功能指标方面,CT与CMR有较好的相关性,但CT略低估以上指标。CMR延迟强化图像的对比噪声比优于CT(P0.01);CT测量的局灶性心肌纤维化范围与CMR结果相关性较好(P0.01)。结论:心脏CT一站式检查能够提供冠状动脉狭窄程度、心室形态、心功能及心肌活性方面的信息,有助于肥厚性心肌病可疑合并冠心病患者的鉴别诊断。     

心肌淀粉样变性的临床特点分析

目的:分析心肌淀粉样变性患者的临床特点,以提高心肌淀粉样变性的早期诊断和治疗水平,提高患者生存率。方法:回顾性分析我院2015-01-2018-04行腹部、肾脏、心内膜等病理活检确诊的27例心肌淀粉样变性患者的临床表现、心电图、超声心动图、心脏磁共振(MRI)特点及治疗效果。结果:心肌淀粉样变性患者发病年龄晚,临床表现不一,以胸闷气促、下肢水肿等表现多见,常累及多个系统。心电图以肢体导联低电压、胸前导联R波递增不良及病理性Q波为主要表现;超声心动图表现为心房增大、心室壁增厚及收缩、舒张功能受限;心脏MRI表现为心室壁延迟强化。结论:心肌淀粉样变性患者缺乏特异性临床表现,诊断困难,治疗效果欠佳,预后差。因此,对于原因不明的心功能不全患者,高度怀疑心肌淀粉样变性时,在未进行心内膜活检情况下,应根据心电图、心脏超声及心脏MRI等检查及心外组织活检明确诊断,为早期诊断和治疗提供帮助。     

心脏超声在心脏淀粉样变中的应用

目的探讨心脏超声在心脏淀粉样变中的应用效果。方法选取我院2012年6月~2015年6月收治的经手术病理确诊为心脏淀粉样变患者80例作为研究对象,所有患者均采用体表心电图及心脏超声检查,并对其诊断特点进行分析。结果经过心脏超声检查显示,所有心脏淀粉样变患者均伴有不同程度的舒张功能减退,左心房出现增大发生率22.5%,心内膜下心肌出现颗粒样反光增强发生率32.5%,合并心包积液发生率45%;心电图显示肢体导联低电压状态发生率35%,伴有胸前导联低电压发生率30%,出现假性梗死Q波发生率35%。结论心脏超声在心脏淀粉样变诊断中具有显著的临床作用,在检测过程中,若心内膜下出现心肌颗粒样的反光增强现象时,应考虑心脏淀粉样变,进一步提高诊断准确率,值得在临床上进一步推广及运用。     

彩色多普勒超声检测重症HFRS患者的心脏功能及其临床意义

应用彩色多普勒超声检查６０例重症肾综合征出血热患者的心脏功能，结果均呈不同程度的室壁增厚、动度减弱，心包增厚，回声增强，心包积液，收缩及舒张功能减退，瓣膜返流。提示ＨＦＲＳ心脏损害是以心肌，心内膜及心包广泛受累的全心炎症。检测ＨＦＲＳ的心脏功能对病情观察及治疗具有指导意义。     

8例多发性骨髓瘤致心肌淀粉样变性临床特点分析

目的探讨多发性骨髓瘤致心肌淀粉样变性患者的临床特征。方法收集2009—2017年首都医科大学附属北京友谊医院收治的8例多发性骨髓瘤导致心肌淀粉样变性患者,分析其临床资料。结果多发性骨髓瘤致心肌淀粉样变性患者常伴心功能不全,且合并心血管系统以外的临床表现。同时出现心电图肢体导联低电压和超声心电图左心室壁增厚是心肌淀粉样变性的特征改变。心脏磁共振成像呈钆延迟显像,临床高度提示心肌淀粉样变性。病理活组织检查可确定诊断。结论心外组织活检结合临床表现、心电图、超声心电图及心脏磁共振成像可确诊心肌淀粉样变性,但此类患者因临床缺乏有效治疗手段,预后较差。     

Clinical significance of endomyocardial biopsy in conjunction with cardiac magnetic resonance imaging to predict left ventricular reverse remodeling in idiopathic dilated cardiomyopathy

Endomyocardial biopsy (EMB) and cardiac magnetic resonance (CMR) are useful modalities to study the characteristics of myocardial tissue. However, the prognostic impact of both diagnostic tools to predict subsequent left ventricular reverse remodeling (LVRR) has not been well elucidated. A total of 187 consecutive patients with idiopathic dilated cardiomyopathy (IDCM) who were treated by optimal pharmacotherapy (OPT) and underwent EMB of the LV wall were investigated. The myocardial specimens were semiquantitatively evaluated measuring cardiomyocyte degeneration (CD), interstitial fibrosis (IF), and hypertrophy. In addition, late gadolinium enhancement (LGE)-CMR was performed in 78 (48 %) patients. Seventy-eight (48 %) patients developed LVRR, defined as a ≥10 % increase in LV ejection fraction with a ≥10 % decrease in indexed LV end-diastolic dimension at 12 months after OPT. Multivariate regression analysis revealed that CD (P = 0.003), but not IF (P = 0.320), was an independent predictor of LVRR. In the patients with not only EMB but also CMR, the CD score and LGE area were independent predictors of LVRR (odds ratios/P values 0.268/0.010, 0.855/<0.001, respectively). The patients with mild CD and negative LGE had a better achievement rate of LVRR than those with severe CD and positive LGE (74 vs. 19 %). A combination of CD score on EMB and LGE-CMR is useful to predict subsequent LVRR in IDCM patients.     

The additional value of gadolinium-enhanced MRI to standard assessment for cardiac involvement in patients with pulmonary sarcoidosis

AIM: To determine whether gadolinium-enhanced cardiac MRI (CMR) was of additional diagnostic value to standard assessment in patients with sarcoidosis who underwent evaluation for cardiac involvement. METHODS: We reviewed the findings in patients with pulmonary sarcoidosis who had been assessed with ECG, Doppler echocardiography, 201Tl scintigraphy, and CMR from 2002 to 2004. RESULTS: Of the 55 evaluated patients, standard evaluation diagnosed cardiac involvement in 13 patients while CMR diagnosed myocardial scarring (mean +/- SD, 2.5 +/- 1.9 segments) [all 6 patients] and impaired systolic left ventricular function (1 patient) in an additional 6 patients. The extent of delayed enhancement correlated with disease duration (p < 0.05), ventricular dimensions and function (p < 0.001), severity of mitral regurgitation (p < 0.05), and the presence of ventricular tachycardias (p < 0.001). Patients in whom cardiac involvement was diagnosed only with CMR had less myocardial scarring and functional impairment (p < 0.05) compared to patients with a diagnosis made by standard assessment. CONCLUSION: CMR provides an accurate estimation of the extent of cardiac involvement and may reveal signs of early infiltration that are not detected by standard assessment. The extent of late enhancement with gadolinium relates to the severity of cardiac involvement and may therefore have prognostic implications.     

Right ventricular dysfunction,late gadolinium enhancement,and female gender predict poor outcome in patients with dilated cardiomyopathy

Aims

Dilated cardiomyopathy (DCM) shows a variable disease course and is associated with significant morbidity and mortality. So far, left ventricular function (LVF) is the major determinant for risk stratification. However, since it has shown to be a poor guide to individual outcome, we studied the prognostic value of cardiovascular magnetic resonance imaging (CMR) parameters, late gadolinium enhancement (LGE) and epicardial adipose tissue (EAT).

Methods and results

140 patients with DCM underwent late gadolinium enhancement (LGE) CMR. During a median follow-up of 3 years, 22 patients (16%) died and another 51 (36%) were hospitalized due to congestive heart failure (CHF). Female gender and right ventricular ejection fraction (RV-EF) below the median of 38% were independent predictors of all-cause mortality in multivariable analysis. In patients who were hospitalized due to CHF, RV-EF below the median of 38% was the only independent predictor in multivariable analysis. When patients where further stratified according to systolic LV-EF, the prognostic value of RV-EF to predict mortality and cardiac morbidity remained unchanged. Looking at DCM patients who died during follow-up compared to those who were hospitalized due to CHF, the former presented with a higher prevalence of LGE as well as reduced indexed EAT.

Conclusion

Female gender, RV-EF and the presence of LGE are of prognostic importance in patients with DCM. Therefore, the present study underlines the role of CMR as an important tool for risk stratification in patients with DCM.     

Baseline cardiac magnetic resonance imaging versus baseline endomyocardial biopsy for the prediction of left ventricular reverse remodeling and prognosis in response to therapy in patients with idiopathic dilated cardiomyopathy

Endomyocardial biopsy (EMB) and late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) imaging performed at baseline are both used to evaluate the extent of myocardial fibrosis. However, no study has directly compared the effectiveness of these diagnostic tools in the prediction of left ventricular reverse remodeling (LVRR) and prognosis in response to therapy in patients with idiopathic dilated cardiomyopathy (IDCM). Seventy-five patients with newly diagnosed IDCM who were undergoing optimal therapy were assessed at baseline using LGE-CMR imaging and EMB; the former measured LGE area and the latter measured collagen volume fraction (CVF) as possible predictive indices of LVRR and cardiac event-free survival. Among all the baseline primary candidate factors with P < 0.2 as per univariate analysis, multivariate analysis indicated that only LGE area was an independent predictor of subsequent LVRR (β = 0.44; 95 % confidence interval (CI) 0.87–2.53; P < 0.001), as indicated by decreasing left ventricular end-systolic volume index over the 1-year follow-up. Kaplan–Meier curves indicated significantly lower cardiac event-free survival rates in patients with LGE at baseline than in patients without (P < 0.01). By contrast, there was no significant difference in prognosis between patients with CVF values above (severe fibrosis) and below (mild fibrosis) the median of 4.9 %. Cox proportional hazard analysis showed that LGE area was an independent predictor of subsequent cardiac events (hazard ratio 1.06; 95 % CI 1.02–1.10; P ≤ 0.01). The degree of myocardial fibrosis estimated by baseline LGE-CMR imaging, but not that estimated by baseline EMB, can predict LVRR and cardiac event-free survival in response to therapy in patients with newly diagnosed IDCM.     

Evaluation of the accuracy of gadolinium-enhanced cardiovascular magnetic resonance in the diagnosis of cardiac sarcoidosis

OBJECTIVES: This study analyzed the accuracy of gadolinium-enhanced cardiovascular magnetic resonance (CMR) for the diagnosis of cardiac sarcoidosis (CS). BACKGROUND: The diagnosis of CS was made according to the guidelines of the Japanese Ministry of Health and Welfare (1993); CMR has not been incorporated into the guidelines, and the diagnostic accuracy of CMR for the diagnosis of CS has not yet been evaluated. METHODS: We performed an analysis of 12-lead electrocardiograms (ECGs), 24-h ambulatory ECGs, echocardiograms, thallium scintigrams, and gadolinium-enhanced CMR studies in 58 biopsy-proven pulmonary sarcoidosis patients assessed for CS. The diagnostic accuracy of CMR for CS was determined using modified Japanese guidelines as the gold standard. RESULTS: The diagnosis of CS was made in 12 of 58 patients (21%); CMR revealed late gadolinium enhancement (LGE), mostly involving basal and lateral segments (73%), in 19 patients. In 8 of the 19 patients, scintigraphy was normal, while patchy LGE was present. The sensitivity and specificity of CMR were 100% (95% confidence interval, 78% to 100%) and 78% (95% confidence interval, 64% to 89%), and the positive and negative predictive values were 55% and 100%, respectively, with an overall accuracy of 83%. CONCLUSIONS: In patients with sarcoidosis, CMR is a useful diagnostic tool to determine cardiac involvement. New diagnostic guidelines should include CMR.     

肥厚型心肌病患者心肌纤维化范围的相关因素分析

目的探讨肥厚型心肌病患者心肌纤维化范围的相关因素。方法该研究为横断面分析性研究,入选2016年1月至2020年5月在云南省第一人民医院住院的肥厚型心肌病患者。通过病案管理系统收集入选患者的一般临床资料。入选者均行心脏磁共振(CMR)检查,以CMR钆对比剂延迟强化(LGE)识别是否存在心肌纤维化及其部位,应用视觉分析法计算LGE范围(LGE%)。根据是否存在LGE分为LGE阳性组和LGE阴性组,进一步根据左心室舒张末期最大室壁厚度(LVMWT)将LGE阳性组患者分为轻度肥厚组、中度肥厚组和重度肥厚组。入选患者均测定外周血N末端B型利钠肽原(NT-proBNP)和心肌肌钙蛋白I(cTnI)水平。结果该研究共入选患者48例,年龄(46.4±14.3)岁,其中男性42例(87.5%)。CMR检查示LGE阳性患者34例(LGE阳性组)占70.8%,阴性者14例(LGE阴性组)。与LGE阴性组比较,LGE阳性组患者较为年轻(P=0.038),纽约心脏协会心功能Ⅲ/Ⅳ级者占比较高(P=0.00)。与LGE阴性组比较,LGE阳性组患者LVMWT较厚(P=0.008),左心室质量指数(LVMI)较大(P=0.001),左心室舒张末期容积(LVEDV)较大(P=0.043),左心室射血分数(LVEF)和心脏指数(CI)均较低(P均<0.05)。LGE阳性组患者血NT-proBNP和cTnI水平均明显高于LGE阴性组[分别为2760.5(1503.4,3783.6)ng/L比861.3(552.2,1092.8)ng/L,P=0.002;0.970(0.448,1.684)μg/L比0.147(0.033,0.251)μg/L,P=0.041]。LGE阳性组患者心肌轻度肥厚者15例(轻度肥厚组)、中度肥厚者10例(中度肥厚组)、重度肥厚者9例(重度肥厚组),3个亚组间LGE%以及NT-proBNP和cTNI均随着心肌肥厚程度增加而增加(P均<0.05)。LGE%与年龄呈负相关性(r=-0.618,P=0.011),与NT-proBNP、cTnI水平呈正相关(分别为,r=0.271,P=0.010;r=0.111,P=0.013),与LVEDV、LVMWT及LVMI均呈正相关(分别为,r=0.438,P=0.09;r=0.735,P=0.001;r=0.532,P=0.034)。结论肥厚型心肌病患者心肌纤维化范围与年龄呈负相关,与血NT-proBNP、cTnI水平以及LVEDV、LVMWT、LVMI均呈正相关。     

Distribution of late gadolinium enhancement in various types of cardiomyopathies:Significance in differential diagnosis,clinical features and prognosis

The recent development of cardiac magnetic resonance(CMR)techniques has allowed detailed analyses of cardiac function and tissue characterization with high spatial resolution.We review characteristic CMR features in ischemic and non-ischemic cardiomyopathies(ICM and NICM),especially in terms of the location and distribution of late gadolinium enhancement(LGE).CMR in ICM shows segmental wall motion abnormalities or wall thinning in a particular coronary arterial territory,and the subendocardial or transmural LGE.LGE in NICM generally does not correspond to any particular coronary artery distribution and is located mostly in the mid-wall to subepicardial layer.The analysis of LGE distribution is valuable to differentiate NICM with diffusely impaired systolic function,including dilated cardiomyopathy,end-stage hypertrophic cardiomyopathy(HCM),cardiac sarcoidosis,and myocarditis,and those with diffuse left ventricular(LV)hypertrophy including HCM,cardiac amyloidosis and Anderson-Fabry disease.A transient low signal intensity LGE in regions of severe LV dysfunction is a particular feature of stress cardiomyopathy.In arrhythmogenic right ventricular cardiomyopathy/dysplasia,an enhancement of right ventricular(RV)wall with functional and morphological changes of RV becomes apparent.Finally,the analyses of LGE distribution have potentials to predict cardiac outcomes and response to treatments.     

Prognostic Value of Late Gadolinium Enhancement Detected on Cardiac Magnetic Resonance in Cardiac Sarcoidosis

BackgroundSarcoidosis is a complex multisystem inflammatory disorder, with approximately 5% of patients having overt cardiac involvement. Patients with cardiac sarcoidosis are at an increased risk of both ventricular arrhythmias and sudden cardiac death. Previous studies have shown that the presence of late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) is associated with an increased risk of mortality and ventricular arrhythmias and may be useful in predicting prognosis.ObjectivesThis systematic review and meta-analysis assessed the value of LGE on CMR imaging in predicting prognosis for patients with known or suspected cardiac sarcoidosis.MethodsThe authors searched the Embase and MEDLINE databases from inception to March 2022 for studies reporting individuals with known or suspected cardiac sarcoidosis referred for CMR with LGE. Outcomes were defined as all-cause mortality, ventricular arrhythmia, or a composite outcome of either death or ventricular arrhythmias. The primary analysis evaluated these outcomes according to the presence of LGE. A secondary analysis evaluated outcomes specifically according to the presence of biventricular LGE.ResultsThirteen studies were included (1,318 participants) in the analysis, with an average participant age of 52.0 years and LGE prevalence of 13% to 70% over a follow-up of 3.1 years. Patients with LGE on CMR vs those without had higher odds of ventricular arrhythmias (odds ratio [OR]: 20.3; 95% CI: 8.1-51.0), all-cause mortality (OR: 3.45; 95% CI: 1.6-7.3), and the composite of both (OR: 9.2; 95% CI: 5.1-16.7). Right ventricular LGE is invariably accompanied by left ventricular LGE. Biventricular LGE is also associated with markedly increased odds of ventricular arrhythmias (OR: 43.6; 95% CI: 16.2-117.2).ConclusionsPatients with known or suspected cardiac sarcoidosis with LGE on CMR have significantly increased odds of both ventricular arrhythmias and all-cause mortality. The presence of biventricular LGE may confer additional prognostic information regarding arrhythmogenic risk.     

Morphologic pattern of late gadolinium enhancement in Takotsubo cardiomyopathy detected by early cardiovascular magnetic resonance

Background:

Takotsubo cardiomyopathy (TTC) presents clinically as an acute coronary syndrome. It is characterized by transient left ventricular wall dyskinesis‐akinesis, without significant epicardial coronary lesions. Late gadolinium enhancement (LGE) sequences on cardiac magnetic resonance (CMR) allow to clarify the pathophysiology in patients with chest pain, elevated troponin, and normal epicardial coronary arteries; in patients with TTC, previous studies have shown absence of LGE.

Hypothesis:

Early CMR in Takotsubo patients could show a morphological pattern of LGE improving clinical diagnosis.

Methods:

Between January 2005 and January 2007, 8 consecutive patients with TTC criteria underwent CMR within the first 3 days of admission. Cine, T2‐weighted, and LGE images were acquired. Patient follow‐up included clinical exam and imaging techniques: echocardiogram on days 3, 7, 30, and 60, and CMR at 3 months.

Results:

Six patients had experienced a previous stressful situation. No significant lesions were found on coronary angiography, and wall motion improvement was noted at 15 (7–30) days. Median EFs at admission and recovery were 46.5% and 65%, respectively. Dyskinesis was midapical in 6 cases, apical in 1 case, and mid‐ventricular in 1 case. Late gadolinium enhancement showed mild hyperenhancement in areas of abnormal wall motion, whereas normal segments had no contrast enhancement. On follow‐up CMR, wall motion was normal without late enhancement.

Conclusions:

Early CMR in TTC demonstrates a special morphological pattern of late gadolinium uptake that might correspond to localized inflammation and edema in the affected area, suggesting diffuse microcirculation damage rather than epicardial vessel involvement. © 2011 Wiley Periodicals, Inc. The authors have no funding, financial relationships, or conflicts of interest to disclose.