Takotsubo cardiomyopathy, a two-stage recovery of left ventricular systolic and diastolic function as determined by cardiac magnetic resonance imaging

TY - JOUR

T1 - Takotsubo cardiomyopathy, a two-stage recovery of left ventricular systolic and diastolic function as determined by cardiac magnetic resonance imaging

AU - Ahtarovski, Kiril Aleksov

AU - Iversen, Kasper Karmark

AU - Christensen, Thomas Emil

AU - Andersson, Hedvig

AU - Grande, Peer

AU - Holmvang, Lene

AU - Bang, Lia

AU - Hasbak, Philip

AU - Lønborg, Jacob Thomsen

AU - Madsen, Per Lav

AU - Engstrøm, Thomas

AU - Vejlstrup, Niels Grove

N1 - Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: [email protected].

PY - 2014/8

Y1 - 2014/8

N2 - Aims Takotsubo cardiomyopathy (TTC) is an entity mimicking acute myocardial infarction, characterized by transient severe systolic heart failure. Echocardiographic studies suggest that diastolic dysfunction is present in TTC at presentation; however, no reports exist regarding the time course of left ventricular (LV) recovery. This study describes the recovery of LV systolic and diastolic function in TTC. We hypothesized that, in TTC, there is diastolic dysfunction at admission, and that recovery is delayed compared with systolic function. Methods and results We enrolled (consecutively 2010-12) 16 patients (mean age 66, range 39-84 years) diagnosed with TTC and 20 healthy matched controls. We performed cardiac magnetic resonance imaging (CMR) at admission, pre-discharge, and 3-month follow-up. Diastolic function was assessed by LV peak filling rate (LVPFR) and left atrial (LA) emptying volumes. At admission, LV ejection fraction was low, increased at pre-discharge (37 ± 6 vs. 58 ± 6%, P < 0.001), and normalized at follow-up (to 65 ± 5%, P = 0.01). LVPFR did not increase during hospitalization (80 ± 3 vs. 89 ± 4 mL/s/m2, P = 0.21), but was normalized at follow-up (to 206 ± 19, P < 0.001; controls, 214 ± 13, P = 0.23). During hospitalization, LA passive emptying volume remained low (6 ± 2 vs. 8 ± 3 mL/m2, P = 0.05) and LA active emptying volume remained high (17 ± 3 vs. 16 ± 3 mL/m2, P = 0.71), whereas LA conduit volume increased (7 ± 3 vs. 23 ± 4 mL/m2, P < 0.001). T2-weighted imaging demonstrated non-coronary distributed apical oedema without contrast enhancement. Conclusion Patients with TTC undergo fast systolic recovery. However, at discharge, profound diastolic dysfunction is demonstrated by CMR. At follow-up, both LV systolic and diastolic function is normalized in patients with recovered TTC.

AB - Aims Takotsubo cardiomyopathy (TTC) is an entity mimicking acute myocardial infarction, characterized by transient severe systolic heart failure. Echocardiographic studies suggest that diastolic dysfunction is present in TTC at presentation; however, no reports exist regarding the time course of left ventricular (LV) recovery. This study describes the recovery of LV systolic and diastolic function in TTC. We hypothesized that, in TTC, there is diastolic dysfunction at admission, and that recovery is delayed compared with systolic function. Methods and results We enrolled (consecutively 2010-12) 16 patients (mean age 66, range 39-84 years) diagnosed with TTC and 20 healthy matched controls. We performed cardiac magnetic resonance imaging (CMR) at admission, pre-discharge, and 3-month follow-up. Diastolic function was assessed by LV peak filling rate (LVPFR) and left atrial (LA) emptying volumes. At admission, LV ejection fraction was low, increased at pre-discharge (37 ± 6 vs. 58 ± 6%, P < 0.001), and normalized at follow-up (to 65 ± 5%, P = 0.01). LVPFR did not increase during hospitalization (80 ± 3 vs. 89 ± 4 mL/s/m2, P = 0.21), but was normalized at follow-up (to 206 ± 19, P < 0.001; controls, 214 ± 13, P = 0.23). During hospitalization, LA passive emptying volume remained low (6 ± 2 vs. 8 ± 3 mL/m2, P = 0.05) and LA active emptying volume remained high (17 ± 3 vs. 16 ± 3 mL/m2, P = 0.71), whereas LA conduit volume increased (7 ± 3 vs. 23 ± 4 mL/m2, P < 0.001). T2-weighted imaging demonstrated non-coronary distributed apical oedema without contrast enhancement. Conclusion Patients with TTC undergo fast systolic recovery. However, at discharge, profound diastolic dysfunction is demonstrated by CMR. At follow-up, both LV systolic and diastolic function is normalized in patients with recovered TTC.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Case-Control Studies

KW - Contrast Media

KW - Denmark

KW - Diastole

KW - Female

KW - Humans

KW - Magnetic Resonance Imaging

KW - Male

KW - Middle Aged

KW - Organometallic Compounds

KW - Prospective Studies

KW - Recovery of Function

KW - Systole

KW - Takotsubo Cardiomyopathy

KW - Ventricular Dysfunction, Left

U2 - 10.1093/ehjci/jeu004

DO - 10.1093/ehjci/jeu004

M3 - Journal article

C2 - 24525137

SN - 2047-2404

VL - 15

SP - 855

EP - 862

JO - European Heart Journal Cardiovascular Imaging

JF - European Heart Journal Cardiovascular Imaging

IS - 8

ER -