Role of T1 mapping in identification of convalescent Takotsubo cardiomyopathy

Abstract

Type of funding sources: None. Takotsubo cardiomyopathy remains an elusive entity to diagnose, especially with increasing time following the initial clinical event. Patients are often referred for cardiac MR, but when performed on a convalescent patient, the conventional CMR exam can be normal. However CMR elevated native T1 values on mapping may persist, aiding diagnosis. We sought to review a series of confirmed Takotsubo cases to evaluate which CMR features were most helpful in making a diagnosis. We reviewed 2 years of CMR exams in our institution and identified 14 patients with a confirmed diagnosis of Takotsubo cardiomyopathy after a read of all clinical data by two consultant cardiologists. All of the 14 patients had a troponin positive cardiac event, unobstructed coronary arteries on invasive angiography and echocardiographic evidence of apical hypo/akinesia (or basal, in the non-apical variants) at the time of presentation. All CMR exams were performed at 1.5T. All included functional assessment, T1 mapping and late gadolinium enhancement(LGE). Some exams also included T2 mapping and STIR. All patients were female. The time interval between presentation and CMR exam varied from 24 hours to 2 years. 2 of the scans showed evidence of non-apical Takotsubo cardiomyopathy. At the time of CMR, only 7 patients(50%) had a residual regional wall motion abnormality, but 13 patients(93%) had a region of elevated native T1 (>1 myocardial segment). High signal was identified on STIR in 6(43%) and elevated native T2 in 10(71%). Of interest, we identified small areas of patchy LGE in 2 patients(14%). Increased native T1 signal may be the only residual cardiac MRI marker of previous Takotsubo cardiomyopathy, persisting for months after the initial cardiac event, even after resolution of regional wall motion abnormalities and recovery of the left ventricular function. T1 mapping should be performed in CMR exams for Takotsubo cardiomyopathy to improve diagnostic yield. Abstract Figure. CMR in convalescent Takotsubo