Yasuyuki Kobayashi MD, Presenter: Nothing to Disclose

Takanori Yasu MD, Abstract Co-Author: Nothing to Disclose

Takeshi Ishida MD, Abstract Co-Author: Nothing to Disclose

Yasuo Nakajima MD, Abstract Co-Author: Nothing to Disclose

Osamu Tanaka MD, Abstract Co-Author: Nothing to Disclose

Kenji Yodo, Abstract Co-Author: Nothing to Disclose

Keisuke Tanno, Abstract Co-Author: Nothing to Disclose

Kunihiro Yagihashi MD, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

Tako-tsubo cardiomyopathy is an enigmatic disease characterized by transient left ventricular dysfunction of a broad area with a hyperkinetic area around the cardiac base. There is ST-segment elevation with no coronary stenosis. The exact mechanism remains unknown. First pass perfusion and late enhancement is used in MRI as a diagnostic tool in various myocardial pathologies such as fibrosis, edema and inflammation. The purpose was to evaluate the efficacy of myocardial perfusion and late enhancement MRI in Tako-tsubo cardiomyopathy.

The subjects were 8 patients with Tako-tsubo cardiomyopathy who underwent pharmalogical stress and/or rest perfusion (both in 6 and only rest in 2) and late enhancement MRI. In 2 cases, follow-up examination was performed between 2 and 3 weeks after onset. All patients underwent Echocardiography and CAG within 10 days of MRI study. Echocardiography and CAG revealed that characteristic wall motion (extensive ventricular apical ballooning and over-contraction of the basis) and coronary arteries are normal. Consequently, Tako-tsubo cardiomyopathy was diagnosed from the clinical course. The MRI system used was a 1.5T MR imager (EXCELART; Toshiba, Tokyo). FFE-EPI sequence for perfusion during and without stress was below; TR/TE=7.1-8.3/2.1ms. And Inversion Recovery sequence for late enhancement was acquired;TR/TE=8.9/3.4ms, TI=180-280ms.

1) In all cases, early defect (ED) was observed in apical ventricular wall on both stress and rest perfusion MRI. ED observed in the apical ventricular wall with low contraction capability in rest perfusion indicates that severe microcirculation failure exists. In 2 cases that was performed follow-up MRI examination, ED in apical ventricular wall remained. 2) In 5 cases out of 8, late enhancement (LE) was observed in the apical ventricular wall, which indicates linear (in 3 cases) or patchy (in 2 cases) pattern.

It is considered that ED can be observed in the apical ventricular wall with low contraction capability, and myocardial ischemia is concerned with the causes of Tako-tsubo cardiomyopathy. First pass perfusion and late enhancement is very useful for diagnosis and clinical course observation

Kobayashi, Y, Yasu, T, Ishida, T, Nakajima, Y, Tanaka, O, Yodo, K, Tanno, K, Yagihashi, K, et al, , Efficacy of First Pass Perfusion and Late Enhancement MRI Imaging in Tako-Tsubo Cardiomyopathy.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4419522.html