Acute phase myocardial edema was related to recovery process of regional left ventricular wall motion abnormality in takotsubo cardiomyopathy

Background: Takotsubo cardiomyopathy (TC, stress cardiomyopathy, apical ballooning syndrome) is characterized by transient reversible systolic dysfunction of the apical and/or mid segments of the left ventricular (LV). However, the recovery process of LV systolic dysfunction is not known in detail. Methods: We retrospectively evaluated 40 consecutive patients (38 women, 2 men) who were diagnosed as TC in our hospital between June 2007 and October 2012. Main outcome was complete recovery of LV wall motion. Clinical characteristics of early recovery group (n=16; LV wall motion recovered completely within 7 days) and late recovery group (n=24; abnormal LV wall motion remained after 7 days) were compared. Then, we recorded cardiovascular magnetic resonance imaging (CMR) within three days after hospitalization in 27 of 40 patients to evaluate an acute phase histological change of the diseased myocardium. Results: A stressful trigger could be identified in 26 patients (mental: 10, physical: 16). Average LV ejection fraction (LVEF) evaluated by left ventriculography was 50%. There were no statistically significant differences about age, coronary risk factor, laboratory data, QTc in electrocardiogram, and LVEF between two groups. Regional myocardial edema (high intensity in T2-weighted images of CMR) could be identified in 5 of 9 patients (56%) in early recovery group and 18 of 18 patients (100%) in late recovery group (P<0.05). ![Figure][1] Figure 1. Regional myocardial edema on CMR Conclusions: Acute phase myocardial edema detected by CMR images may relate to recovery process of LV wall motion abnormality in TC patients. [1]: pending:yes