Cardiac MRI Critical in Diagnosing Takotsubo Cardiomyopathy

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About 30% of patients initially thought to have Takotsubo cardiomyopathy were eventually diagnosed with apical infarction.
About 30% of patients initially thought to have Takotsubo cardiomyopathy were eventually diagnosed with apical infarction.

WASHINGTON, DC — Patients with a presumed diagnosis of Takotsubo cardiomyopathy should undergo cardiac MRI to rule out late gadolinium enhancement (LGE) in order to differentiate it from apical infarction, according to research presented at the 66th Annual Scientific Sessions & Expo of the American College of Cardiology.

Researchers at the NYU School of Medicine in New York City studied 833 consecutive patients with myocardial infarction who underwent angiography at NYU Langone Medical Center between April 2014 and September 2016 undergoing angiography. Data were prospectively entered into a registry. The investigators aimed to determine what proportion of patients were diagnosed with Takotsubo cardiomyopathy as opposed to myocardial infarction with non-obstructive coronary artery disease (MINOCA).

A total of 125 patients (15%) = entered into the registry had MINOCA. Of these patients, 20 had left ventricular wall motion abnormalities consistent with Takotsubo cardiomyopathy. Of the 7 patients who underwent cardiac MRI, 2 were found to have apical transmural (ischemic pattern) LGE. The remaining 18 had no LGE, suggesting a provisional diagnosis of Takotsubo cardiomyopathy. This corresponded to 14% of patients given a MINOCA diagnosis.

Those with a provisional diagnosis of Takotsubo cardiomyopathy were more likely to be women (79% vs 51%; P =.02), with similar age and peak troponin levels (64±16 years vs 69±10 years; P =.15 and median: 1.17; interquartile range [IQR]: 0.3-2.72 ng/mL vs median: 0.69; IQR: 0.16-2.29 ng/mL; P =.38).

Twenty nine percent of patients with wall motion pattern abnormalities consistent with Takotsubo cardiomyopathy undergoing cardiac MRI ultimately were diagnosed with apical infarction.

“[Cardiac MRI] should strongly be considered in cases of presumed [Takotsubo cardiomyopathy], to distinguish it from apical infection,” the researchers concluded.

Reference

Ghandi H, Rodriguez JE, Reynolds H. Takotsubo cardiomyopathy vs apical infarction in patients with myocardial infarction and non-obstructive coronary artery disease (MINOCA). Abstract 1297-316. Presented at: the 66th Scientific Session & Expo of the American College of Cardiology. March 17-19, 2017; Washington, DC.

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