CMR Estimation of Filling Pressures in Left Ventricular Hypertrophy: A Comparison with Tissue Doppler and Invasive Measurements

Introduction: Tako–Tsubo cardiomyopathy has been reported in Japan and is characterized by transient left ventricular (LV) apical ballooning and reversible LV asynergy in the absence of significant coronary artery disease. This syndrome usually presents clinically as acute myocardial infarction (MI). However, in contrast to acute MI, Tako–Tsubo cardiomyopathy has a benign outcome with full recovery of wall motion within a few weeks and therefore does not require thrombolytic treatment or angioplasty. Methods and Results: Gd-enhanced contrast CMR is well established for the detection of acute and chronic ischemic myocardial injury and may thus permit a differentiation between Tako–Tsubo cardiomyopathy and acute MI in the acute setting. Contrast CMR imaging using an IR FLASH technique (constantly adapting TI to null normal myocardium) was performed in 11 patients (mean age 66+7 yrs.) presenting with typical apical LV ballooning, LV asynergy and normal coronary arteries, in average three days after cardiac catheterization. In 10 of the 11 patients no contrast enhancement was present. One patient showed evidence of a small myocardial damage in the inferior apical region which morphologically looked like coronary embolism of a side branch in the circumflex region. Acute or chronic myocarditis as possible cause for the transient wall motion abnormality has been ruled out by endomyocardial biopsy in all patients (Fig. 1). Conclusions: Tako–Tsubo cardiomyopathy is not an exclusively Japanese phenomenon. It is also present in Europe and therefore must be differentiated from acute myocardial infarction in the clinical routine. Contrast CMR is a valuable tool for the non-invasive differentiation of those disease entities in the acute phase and may be useful for therapeutic decision making.