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      Reversible Left Ventricular Wall Thickening with Takotsubo Syndrome Sequentially Detected by Cardiac Magnetic Resonance Imaging

      case-report

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          Abstract

          Recently, it has been reported that spontaneous left ventricular wall thickening occurs among patients with takotsubo syndrome, which affects the long-term prognosis of such patients due to cerebral and cardiac complications. We herein report two cases of transient left ventricular wall thickening with takotsubo syndrome in which sequential cardiac magnetic resonance imaging revealed the existence of edematous changes in the thickened wall. Notably, a left ventricular aneurysm was detected during the course of ventricular wall thickening and may have played a role in the development of serious complications accompanied by takotsubo syndrome. This is the first case report of left ventricular aneurysm occurring with ventricular wall thickening due to takotsubo syndrome.

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          Apical hypertrophic cardiomyopathy: clinical follow-up and diagnostic correlates.

          Z Sasson, H Rakowski, P. Liu … (1989)
          To determine the clinical course of apical hypertrophic cardiomyopathy, 26 patients (mean age 45 years) with asymmetric apical hypertrophy diagnosed by echocardiography or angiography were followed up for an average of 7.3 years (range 1 to 22). Presenting symptoms included atypical chest pain (n = 10), typical angina (n = 6), dyspnea (n = 5) and palpitation (n = 8). Ten patients were asymptomatic. At follow-up all patients had inverted precordial T waves, and 14 had the syndrome of "giant T wave negativity" (greater than or equal to 10 mm). In six patients with electrocardiographic follow-up of greater than 10 years (mean 13.4), precordial T wave inversion had progressed from -0.8 +/- 3.9 to -11.2 +/- 8.0 mm in lead V4 in association with increased QRS amplitude. Episodic atrial fibrillation occurred in 4 of 10 patients with echocardiographic left atrial enlargement. Although left ventricular systolic function was normal, diastolic relaxation was impaired in comparison with values in 10 healthy control subjects: in all 18 patients studied peak filling rate was decreased (4.44 +/- 0.44 versus 6.13 +/- 1.54 stroke volumes/s); time to peak filling was increased (174 +/- 40 versus 147 +/- 32 ms); and atrial systolic contribution to ventricular end-diastolic volume was increased (21.5 +/- 6.8 versus 11.5 +/- 4.6 stroke volume %). During follow-up, 21 of the 26 patients remained in stable condition or were asymptomatic. One patient with normal coronary arteries had an apical myocardial infarction with development of a discrete apical aneurysm and loss of "giant T wave negativity." This patient was the only one to have documented life-threatening ventricular arrhythmias.(ABSTRACT TRUNCATED AT 250 WORDS)
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            Myocardial edema in Takotsubo syndrome mimicking apical hypertrophic cardiomyopathy: An insight into diagnosis by cardiovascular magnetic resonance.

            Cemil Izgi, Sanjoy Ray, Evangelia Nyktari … (2015)
            Myocardial edema is one of the characteristic features in the pathogenesis of Takotsubo syndrome. We report a middle aged man who presented with typical clinical and echocardiographic features of apical variant of Takotsubo syndrome. However, a cardiovascular magnetic resonance study performed 10 days after presentation did not show any apical 'ballooning' but revealed features of an apical hypertrophic cardiomyopathy on cine images. Tissue characterization with T2 weighted images proved severe edema as the cause of significantly increased apical wall thickness. A follow-up cardiovascular magnetic resonance study was performed 5 months later which showed that edema, wall thickening and the appearance of apical hypertrophic cardiomyopathy all resolved, confirming Takotsubo syndrome as the cause of the initial appearance. As the affected myocardium most commonly involves the apical segments, an edema induced increase in apical wall thickness may lead to appearances of an apical hypertrophic cardiomyopathy rather than apical ballooning in the acute to subacute phase of Takotsubo syndrome.
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              Two cases of reversible left ventricular hypertrophy during recovery from takotsubo cardiomyopathy.

              Takao Kato, Yoko Ban, Saori Kuruma … (2013)
              We report 2 cases of reversible ventricular hypertrophy in patients with takotsubo cardiomyopathy (stress-induced cardiomyopathy) during recovery of cardiac function. The first case involved a 72-year-old woman who presented with cerebral infarction. On admission, an elevated troponin I and decreased apical wall motion were observed with normal myocardial perfusion imaging. The second case involved a 79-year-old woman who presented with angina, anxiety resulting from emotional stress, slightly decreased apical wall motion, and normal epicardial arteries. In both cases, apical hypertrophy of the left ventricle was observed at approximately 3 weeks after onset, when the wall motion had improved. The ventricular wall gradually became thinner over time. To our knowledge, this is the first report of reversible ventricular hypertrophy in patients with takotsubo cardiomyopathy. We hypothesize the hypertrophic signaling in the myocardium was stimulated by catecholamines, which are the suggested etiology of takotsubo cardiomyopathy, and the hypertrophied myocardium gradually returned to normal as the syndrome receded.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Intern Med
                Journal ID (iso-abbrev): Intern. Med
                Title: Internal Medicine
                Publisher: The Japanese Society of Internal Medicine
                ISSN (Print): 0918-2918
                ISSN (Electronic): 1349-7235
                Publication date (Electronic): 8 December 2017
                Publication date (Print): 15 February 2018
                Volume: 57
                Issue: 4
                Pages: 517-522
                Affiliations
                [1 ]Cardiovascular Center, The Tazuke Kofukai Medical Research Institute Kitano Hospital, Japan
                [2 ]Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Japan
                Author notes

                Correspondence to Dr.　Masahiro Kimura, mkimura@ 123456kuhp.kyoto-u.ac.jp

                Article
                DOI: 10.2169/internalmedicine.9065-17
                PMC ID: 5849547
                PubMed ID: 29225248
                SO-VID: 08340285-2bb3-448c-88ed-f864c511ea3e
                Copyright © Copyright © 2018 by The Japanese Society of Internal Medicine
                License:

                The Internal Medicine is an Open Access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view the details of this license, please visit ( https://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 20 February 2017
                Date accepted : 5 July 2017
                Categories
                Subject: Case Report

                Keywords: ventricular aneurysm,cardiac mri,myocardial edema,takotsubo cardiomyopathy,hypertrophy,takotsubo syndrome
                Data availability:
                Keywords: ventricular aneurysm, cardiac mri, myocardial edema, takotsubo cardiomyopathy, hypertrophy, takotsubo syndrome

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