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In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
08:13

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Published on: February 16, 2016

Delayed hyperenhancement in a case of Takotsubo cardiomyopathy

Dariusch Haghi1, Stephan Fluechter, Tim Suselbeck

  • 1Medical Department, University Hospital Mannheim, Mannheim, Germany. dariush.haghi@med.ma.uni-heidelberg.de

Journal of Cardiovascular Magnetic Resonance : Official Journal of the Society for Cardiovascular Magnetic Resonance
|December 16, 2005
PubMed

Insights

Takotsubo cardiomyopathy (TTC) is a heart condition with transient left ventricular dysfunction. This case study shows a rare instance of subendocardial delayed hyperenhancement on cardiac MRI in a TTC patient, which resolved over time.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging

Background:

  • Takotsubo cardiomyopathy (TTC) presents as acute, transient left ventricular dysfunction without coronary stenosis.
  • Contrast-enhanced cardiovascular magnetic resonance (CMR) aids in TTC diagnosis.
  • Delayed hyperenhancement on CMR typically indicates inflammation or fibrosis, and is usually absent in TTC.

Observation:

  • A 46-year-old woman with TTC exhibited extensive apical and midventricular akinesia.
  • Gadolinium-enhanced CMR revealed a small area of subendocardial delayed hyperenhancement in the affected regions.
  • Follow-up CMR after 6 weeks showed complete resolution of wall motion abnormalities and persistent, identical subendocardial delayed hyperenhancement.

Findings:

  • The presence of subendocardial delayed hyperenhancement in TTC is rare.
  • This finding, typically associated with myocardial injury, resolved concurrently with the clinical and functional recovery in this TTC case.
  • The persistence of the enhancement pattern despite wall motion recovery suggests a potential non-infarct-related myocardial substrate.

Implications:

  • This case challenges the typical understanding of delayed hyperenhancement in TTC.
  • It suggests that subendocardial enhancement in TTC may not always represent irreversible myocardial fibrosis or active inflammation.
  • Further research is needed to elucidate the exact nature and significance of delayed hyperenhancement in Takotsubo cardiomyopathy.

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