Clinical History:
This 70-year-old woman presented to the emergency room with acute onset of severe chest pain. No prior history of trauma. The pain started after a quarrel with her 45-year old daughter. The electrocardiogram did not reveal evidence of ischemic ST segment deviations. Creatinine kinase was of borderline value (10 U/L), but cardiac troponin T was elevated (2.15 µg/L). Coronary artery disease was ruled out by emergency coronary angiography. However, left ventricular angiography demonstrated apical ballooning with a reduced left ventricular ejection fraction.
Diagnosis:
Takotsubo cardiomyopathy.
MR Technique:
The exam was acquired on a 36-channel 1.5 T scanner (Siemens MAGNETOM Avanto) using a dedicated phased array cardiac coil. Images were acquired during breath-holding in mild expiration. Scout images (coronal, sagittal and axial planes) were obtained for planning of the final double-oblique long-axis and short-axis views. To evaluate functional parameters, ECG-gated cine images were then acquired using a balanced segmented steady state free precession (trueFISP) sequence. The scan parameters were: 8 mm slice thickness with 10 mm interslice gap, temporal resolution 63.7 ms, repetition time 63.5 ms, echo time 1.1 ms, flip angle 55 degrees, and typical in-plane spatial resolution 2.0 × 2.8 mm2. After obtaining standard 4, 3 and 2 chamber long axis cines, a stack of 9 to 12 short-axis slices was used for full coverage of the left and right ventricle. Late gadolinium chelate enhancement images were obtained 10 min after intravenous administration of 0.2 mmol·kg-1 0.5M GBCA, using an inversion recovery turbo Fast Low Angle Shot (FLASH) sequence with 6 mm slice thickness at the same position as the long- and short-axis cines in end diastole.
Imaging Findings:
Dilated left ventricle with apical ballooning is demonstrated with slightly reduced left ventricular function (left ventricular ejection fraction 46%, normalized end diastolic volume 87 ml/m2, normalized end systolic volume 47 ml/m2, normalized stroke volume 40 ml/m2). No myocardial hypertrophy (SWT 6 mm, PWT 9 mm, normalized myocardial mass 35 g/ m2) or myocardial scar formation was found. These findings are compatible with a Tako-Tsubo-cardiomyopathy. Accompanying pleural effusions were also noted (not illustrated).
