Images in cardiovascular medicine. No delayed enhancement on contrast magnetic resonance imaging with Takotsubo cardiomyopathy.

An 88-year-old woman was referred to our hospital because of severe chest pain. The ECG in leads II, III, aVF, and V1 through V5 showed ST elevation (Figure 1). The creatinine kinase and creatinine kinase MB were 324 and 18 IU/L, respectively. Emergency coronary angiography revealed 75% stenosis of the high lateral branch, but left ventriculography confirmed the presence of severe apical ballooning with basal hypercontraction. The left ventricle was observed as an ampulla (Figure 2), and the patient was diagnosed as having Takotsubo cardiomyopathy. Cardiac MRI was performed on days 2 and 25. Steady-state (true FISP) cine MRI demonstrated basal hypercontraction, apical akinesis and ballooning, and thinning of the ventricular wall in its apical portion on day 2 (Figure 3A), but left ventricular dyskinesis and thinning of the ventricular wall improved on day 25 (Figure 3B). After bolus injection of gadolinium-DTPA, delayedenhancement imaging was performed with the inversion recovery technique. There was no hyperenhancement of the apical region either on day 2 or on day 25 (Figure 4). This case demonstrated that in Takotsubo cardiomyopathy, the apical portion showing akinesis, thinning, and ballooning did not undergo irreversible damage as evaluated with a combination of functional cine images and delayed-contrast enhancement of cardiac MRI.