Dipartimento di Scienze Radiologiche Oncologiche ed Anatomo-Patologiche, Sapienza, Università degli Studi di Roma, V.le Regina Elena 324, 00161, Roma, Italy.
Radiol Med. 2013 Dec;118(8):1309-23. doi: 10.1007/s11547-013-0931-1. Epub 2013 May 27.
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.
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.
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%).
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.
心肌梗死后心尖球形综合征（Takotsubo 心肌病，TT-CMP）的主要特征是短暂性缺血，伴有完全可逆的区域性收缩功能障碍，累及心尖中段节段，且无冠状动脉疾病（CAD）的血管造影征象。急性和可逆性心肌损伤表明组织水肿可能是疾病的一个重要标志物。
17 例临床和血管造影诊断为 TT-CMP 的患者在急性期和 4 个月后随访时进行了心血管磁共振（CMR）成像。采用标准采集方案，包括涡轮自旋回波（TSE）T2 加权短反转时间恢复（T2 STIR）、稳态自由进动电影（SSFP cine）和钆苯丙氨酸四乙酸（Gd-BOPTA）给药后的晚期增强（LE）成像。对所有图像进行分析，并将水肿和 LE 的数据与区域性功能障碍和心内膜心肌活检（EMB）的组织学发现相关联（如有）。
在所有患者中，T2 STIR 图像均显示弥漫性均匀高信号，延伸至所有心尖中段节段，与区域性功能障碍区域完全匹配，反映了组织水肿。在接受 EMB 的五名患者中，组织学证实了与典型收缩带坏死相关的大量间质水肿。未观察到 LE 病例。在随访时，所有患者的水肿均完全消退，区域性和整体左心室（LV）功能显著恢复（射血分数从 48.7%增加到 59.8%）。
CMR 上的心肌水肿是急性 TT-CMP 的特征性表现，反映了急性炎症和急性心肌损伤。因此，它可以用作疾病严重程度的特异性标志物。
