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Cardiovascular magnetic resonance T2 signal abnormalities in left ventricular ballooning syndrome

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Abstract

Left ventricular ballooning syndrome (LVBS), also known as Takotsubo cardiomyopathy, is characterized by regional left ventricular dysfunction associated with severe psychological stress. T2 weighted cardiac magnetic resonance (CMR) can identify myocardial edema due to ischemia or other insults. A standard clinical CMR scan with double inversion recovery fast spin echo T2 weighted sequences was performed on consecutive patients with LVBS. T2 signal was compared in myocardial segments with normal and impaired function based on systolic wall thickening (SWT). Eight LVBS patients were identified, all female, with a median age of 61 years and median left ventricular ejection fraction of 52%. Four patients had apical ballooning and four had mid-wall or basal ballooning. In severely dysfunctional segments (those with SWT < 25%), the median percentage of high T2 signal was 85 compared with 35 in those with SWT > 25% (P < 0.001). When the segments were categorized into tertiles based on SWT, the percentage of high T2 signal was greatest in segments with the worst function (68% vs. 43% vs. 31%, P = 0.005). In the five patients who returned for follow up, there was a significant reduction in high T2 signal compared with baseline in those segments that were initially severely dysfunctional (85% vs. 35%, P < 0.001). In conclusion, we describe elevated T2 signal consistent with myocardial edema in patients with LVBS. The T2 signal is highest in myocardium with the most impaired function and resolves over time.

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Authors and Affiliations

  1. Section of Cardiology, Department of Medicine, Washington Hospital Center, Washington, DC, USA

    Subodh B. Joshi, Tania Chao, Peter R. Zeman, Howard A. Cooper, Joseph Lindsay & Anthon R. Fuisz

  2. Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston, MA, 02114-2750, USA

    Subodh B. Joshi

  3. Clinical Sites Research Program, Philips Research North America, Bethesda, MD, USA

    Daniel A. Herzka

Authors
  1. Subodh B. Joshi
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  2. Tania Chao
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  3. Daniel A. Herzka
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  4. Peter R. Zeman
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  5. Howard A. Cooper
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  6. Joseph Lindsay
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  7. Anthon R. Fuisz
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Correspondence to Subodh B. Joshi.

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Medis Medical Imaging Systems (Leiden, The Netherlands) for QMASS software.

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Joshi, S.B., Chao, T., Herzka, D.A. et al. Cardiovascular magnetic resonance T2 signal abnormalities in left ventricular ballooning syndrome. Int J Cardiovasc Imaging 26, 227–232 (2010). https://doi.org/10.1007/s10554-009-9515-5

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  • DOI: https://doi.org/10.1007/s10554-009-9515-5

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