L'edema miocardico come marker di danno acuto nella cardiomiopatia di Takotsubo: Valutazione con risonanza magnetica cardiaca

Translated title of the contribution: Myocardial oedema as the sole marker of acute injury in Takotsubo cardiomyopathy: A cardiovascular magnetic resonance (CMR) study

Ilaria Iacucci, Iacopo Carbone, Giuseppe Cannavale, Bettina Conti, Ilaria Iampieri, Riccardo Rosati, Gennaro Sardella, Andrea Frustaci, Francesco Fedele, Carlo Catalano, Marco Francone

Research output: Contribution to journalArticle

Abstract

Purpose. The main hallmark of Takotsubo cardiomyopathy (TT-CMP) is transient ischaemia, with completely reversible regional contractile dysfunction, which involves the mid-apical segments and shows no angiographic signs of coronary artery disease (CAD). The acute and reversible myocardial injury suggests that tissue oedema may be an important marker of disease. Materials and methods. Seventeen patients with a clinical and angiographic diagnosis of TT-CMP underwent cardiovascular magnetic resonance (CMR) imaging in the acute phase and at follow-up after 4 months. A standard acquisition protocol including turbo spin echo (TSE) T2-weighted short-tau inversion-recovery (T2 STIR), steady-state free-precession cine (SSFP cine) and lateenhancement (LE) imaging after gadolinium benzyloxypropionic tetraacetic acid (Gd-BOPTA) administration was performed. All images were analysed, and data on oedema and LE were correlated with regional dysfunction and histological findings from endomyocardial biopsy (EMB) where available. Results. In all patients, T2 STIR images showed a diffuse homogeneous hyperintensity that extended to all mid-apical segments and perfectly matched the area of regional dysfunction, reflecting tissue oedema. In the five patients who underwent EMB, histology confirmed the massive interstitial oedema associated with typical contraction-band necrosis. No cases of LE were observed. At follow-up, complete regression of oedema was observed in all cases, with significant recovery of regional and global left ventricular (LV) function (ejection fraction from 48.7% to 59.8%). Conclusions. Myocardial oedema on CMR is a characteristic feature of acute TT-CMP, which reflects acute inflammation and acute myocardial injury. It could therefore be used as a specific marker of disease severity.

Original languageItalian
Pages (from-to)1309-1323
Number of pages15
JournalRadiologia Medica
Volume118
Issue number8
DOIs
Publication statusPublished - Dec 2013

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Takotsubo Cardiomyopathy
Edema
Magnetic Resonance Spectroscopy
Wounds and Injuries
Biopsy
Gadolinium
Left Ventricular Function
Stroke Volume
Coronary Artery Disease
Histology
Necrosis
Ischemia
Magnetic Resonance Imaging
Inflammation
Acids

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

Cite this

Iacucci, I., Carbone, I., Cannavale, G., Conti, B., Iampieri, I., Rosati, R., ... Francone, M. (2013). L'edema miocardico come marker di danno acuto nella cardiomiopatia di Takotsubo: Valutazione con risonanza magnetica cardiaca. Radiologia Medica, 118(8), 1309-1323. https://doi.org/10.1007/s11547-013-0931-1

L'edema miocardico come marker di danno acuto nella cardiomiopatia di Takotsubo : Valutazione con risonanza magnetica cardiaca. / Iacucci, Ilaria; Carbone, Iacopo; Cannavale, Giuseppe; Conti, Bettina; Iampieri, Ilaria; Rosati, Riccardo; Sardella, Gennaro; Frustaci, Andrea; Fedele, Francesco; Catalano, Carlo; Francone, Marco.

In: Radiologia Medica, Vol. 118, No. 8, 12.2013, p. 1309-1323.

Research output: Contribution to journalArticle

Iacucci, I, Carbone, I, Cannavale, G, Conti, B, Iampieri, I, Rosati, R, Sardella, G, Frustaci, A, Fedele, F, Catalano, C & Francone, M 2013, 'L'edema miocardico come marker di danno acuto nella cardiomiopatia di Takotsubo: Valutazione con risonanza magnetica cardiaca', Radiologia Medica, vol. 118, no. 8, pp. 1309-1323. https://doi.org/10.1007/s11547-013-0931-1
Iacucci, Ilaria ; Carbone, Iacopo ; Cannavale, Giuseppe ; Conti, Bettina ; Iampieri, Ilaria ; Rosati, Riccardo ; Sardella, Gennaro ; Frustaci, Andrea ; Fedele, Francesco ; Catalano, Carlo ; Francone, Marco. / L'edema miocardico come marker di danno acuto nella cardiomiopatia di Takotsubo : Valutazione con risonanza magnetica cardiaca. In: Radiologia Medica. 2013 ; Vol. 118, No. 8. pp. 1309-1323.
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abstract = "Purpose. The main hallmark of Takotsubo cardiomyopathy (TT-CMP) is transient ischaemia, with completely reversible regional contractile dysfunction, which involves the mid-apical segments and shows no angiographic signs of coronary artery disease (CAD). The acute and reversible myocardial injury suggests that tissue oedema may be an important marker of disease. Materials and methods. Seventeen patients with a clinical and angiographic diagnosis of TT-CMP underwent cardiovascular magnetic resonance (CMR) imaging in the acute phase and at follow-up after 4 months. A standard acquisition protocol including turbo spin echo (TSE) T2-weighted short-tau inversion-recovery (T2 STIR), steady-state free-precession cine (SSFP cine) and lateenhancement (LE) imaging after gadolinium benzyloxypropionic tetraacetic acid (Gd-BOPTA) administration was performed. All images were analysed, and data on oedema and LE were correlated with regional dysfunction and histological findings from endomyocardial biopsy (EMB) where available. Results. In all patients, T2 STIR images showed a diffuse homogeneous hyperintensity that extended to all mid-apical segments and perfectly matched the area of regional dysfunction, reflecting tissue oedema. In the five patients who underwent EMB, histology confirmed the massive interstitial oedema associated with typical contraction-band necrosis. No cases of LE were observed. At follow-up, complete regression of oedema was observed in all cases, with significant recovery of regional and global left ventricular (LV) function (ejection fraction from 48.7{\%} to 59.8{\%}). Conclusions. Myocardial oedema on CMR is a characteristic feature of acute TT-CMP, which reflects acute inflammation and acute myocardial injury. It could therefore be used as a specific marker of disease severity.",
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T1 - L'edema miocardico come marker di danno acuto nella cardiomiopatia di Takotsubo

T2 - Valutazione con risonanza magnetica cardiaca

AU - Iacucci, Ilaria

AU - Carbone, Iacopo

AU - Cannavale, Giuseppe

AU - Conti, Bettina

AU - Iampieri, Ilaria

AU - Rosati, Riccardo

AU - Sardella, Gennaro

AU - Frustaci, Andrea

AU - Fedele, Francesco

AU - Catalano, Carlo

AU - Francone, Marco

PY - 2013/12

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N2 - Purpose. The main hallmark of Takotsubo cardiomyopathy (TT-CMP) is transient ischaemia, with completely reversible regional contractile dysfunction, which involves the mid-apical segments and shows no angiographic signs of coronary artery disease (CAD). The acute and reversible myocardial injury suggests that tissue oedema may be an important marker of disease. Materials and methods. Seventeen patients with a clinical and angiographic diagnosis of TT-CMP underwent cardiovascular magnetic resonance (CMR) imaging in the acute phase and at follow-up after 4 months. A standard acquisition protocol including turbo spin echo (TSE) T2-weighted short-tau inversion-recovery (T2 STIR), steady-state free-precession cine (SSFP cine) and lateenhancement (LE) imaging after gadolinium benzyloxypropionic tetraacetic acid (Gd-BOPTA) administration was performed. All images were analysed, and data on oedema and LE were correlated with regional dysfunction and histological findings from endomyocardial biopsy (EMB) where available. Results. In all patients, T2 STIR images showed a diffuse homogeneous hyperintensity that extended to all mid-apical segments and perfectly matched the area of regional dysfunction, reflecting tissue oedema. In the five patients who underwent EMB, histology confirmed the massive interstitial oedema associated with typical contraction-band necrosis. No cases of LE were observed. At follow-up, complete regression of oedema was observed in all cases, with significant recovery of regional and global left ventricular (LV) function (ejection fraction from 48.7% to 59.8%). Conclusions. Myocardial oedema on CMR is a characteristic feature of acute TT-CMP, which reflects acute inflammation and acute myocardial injury. It could therefore be used as a specific marker of disease severity.

AB - Purpose. The main hallmark of Takotsubo cardiomyopathy (TT-CMP) is transient ischaemia, with completely reversible regional contractile dysfunction, which involves the mid-apical segments and shows no angiographic signs of coronary artery disease (CAD). The acute and reversible myocardial injury suggests that tissue oedema may be an important marker of disease. Materials and methods. Seventeen patients with a clinical and angiographic diagnosis of TT-CMP underwent cardiovascular magnetic resonance (CMR) imaging in the acute phase and at follow-up after 4 months. A standard acquisition protocol including turbo spin echo (TSE) T2-weighted short-tau inversion-recovery (T2 STIR), steady-state free-precession cine (SSFP cine) and lateenhancement (LE) imaging after gadolinium benzyloxypropionic tetraacetic acid (Gd-BOPTA) administration was performed. All images were analysed, and data on oedema and LE were correlated with regional dysfunction and histological findings from endomyocardial biopsy (EMB) where available. Results. In all patients, T2 STIR images showed a diffuse homogeneous hyperintensity that extended to all mid-apical segments and perfectly matched the area of regional dysfunction, reflecting tissue oedema. In the five patients who underwent EMB, histology confirmed the massive interstitial oedema associated with typical contraction-band necrosis. No cases of LE were observed. At follow-up, complete regression of oedema was observed in all cases, with significant recovery of regional and global left ventricular (LV) function (ejection fraction from 48.7% to 59.8%). Conclusions. Myocardial oedema on CMR is a characteristic feature of acute TT-CMP, which reflects acute inflammation and acute myocardial injury. It could therefore be used as a specific marker of disease severity.

KW - Magnetic resonance imaging

KW - Myocardial oedema

KW - Takotsubo cardiomyopathy

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