Increased ventricular wall stress and late gadolinium enhancement in Takotsubo cardiomyopathy

Abstract

Left ventricular (LV) transient ballooning or the so-called Takotsubo syndrome is a rare disease predominantly occurring in elderly females subsequently to emotional stress disorders. Patients present with acute chest pain, occasionally dyspnea and exhibit regional LV wall motion abnormalities, bearing resemblance to myocardial infarction, although relevant coronary obstruction is not present [ [1] Hurst R.T. Prasad A. Askew 3rd, J.W. Sengupta P.P. Tajik A.J. Takotsubo cardiomyopathy: a unique cardiomyopathy with variable ventricular morphology. JACC Cardiovasc Imaging. 2010; 3: 641-649 Abstract Full Text Full Text PDF PubMed Scopus (181) Google Scholar ]. Besides the typical and eponymous apical type of LV ballooning, biventricular, midventricular and rare basal types have also been described [ [2] Eitel I. von Knobelsdorff-Brenkenhoff F. Bernhardt P. et al. Clinical characteristics and cardiovascular magnetic resonance findings in stress (Takotsubo) cardiomyopathy. JAMA. 2011; 306: 277-286 Crossref PubMed Scopus (568) Google Scholar ]. Usually, complaints and cardiac impairment are of transient nature and completely reversible. Although a preceding excessive catecholamine liberation during distress has been assumed, causes are not yet really known and pathophysiological mechanisms are still discussed controversially. Due to increased cardiac load and distending forces, it can be assumed that ventricular wall stress is increased. Patients with Takotsubo syndrome frequently have increased levels of plasma brain natriuretic peptide (BNP). BNP correlates with increased ventricular wall stress [ [3] Alter P. Rupp H. Rominger M.B. et al. B-type natriuretic peptide and wall stress in dilated human heart. Mol Cell Biochem. 2008; 314: 179-191 Crossref PubMed Scopus (45) Google Scholar ]. Cardiac magnetic resonance (CMR) imaging favorably allows assessment of cardiac function, mass and myocardial morphology including late gadolinium enhancement (LGE). Thus, it is hypothesized the need to evaluate LV wall stress based on CMR measurements in Takotsubo cardiomyopathy.