Slowly resolving global myocardial inflammation/oedema in Tako-Tsubo cardiomyopathy: evidence from T2-weighted cardiac MRI

Christopher Neil, Thanh Ha Nguyen, Angela Kucia, Benjamin Crouch, Aaron Sverdlov, Yuliy Chirkov, Gnanadevan Mahadavan, Joseph Selvanayagam, Dana Dawson, John Beltrame, Christopher Zeitz, Steven Unger, Thomas Redpath, Michael Frenneaux, John Horowitz

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Abstract

Objective Tako-Tsubo cardiomyopathy (TTC) is associated with regional left ventricular dysfunction, independent of the presence of fixed coronary artery disease. Previous studies have used T2-weighted cardiac MRI to demonstrate the presence of periapical oedema. The authors sought to determine the distribution, resolution and correlates of oedema in TTC.

Patients 32 patients with TTC were evaluated at a median of 2 days after presentation, along with 10 age-matched female controls. Extent of oedema was quantified both regionally and globally; scanning was repeated in patients with TTC after 3 months. Correlations were sought between oedema and the extent of hypokinesis, catecholamine release, release of N-terminal prohormone of B-type natriuretic peptide (NT-proBNP), and markers of systemic inflammatory activation (high-sensitivity C-reactive protein and platelet response to nitric oxide).

Results In the acute phase of TTC, T2-weighted signal intensity was greater at the apex than at the base (p<0.0001) but was nevertheless significantly elevated at the base (p<0.0001), relative to control values. Over 3 months, T2-weighted signal decreased substantially, but remained abnormally elevated (p<0.02). The regional extent of oedema correlated inversely with radial myocardial strain (except at the apex). There were also direct correlations between global T2-weighted signal and (1) plasma normetanephrine (r=0.39, p=0.04) and (2) peak NT-proBNP (r=0.39, p=0.03), but not with systemic inflammatory markers.

Conclusions TTC is associated with slowly resolving global myocardial oedema, the acute extent of which correlates with regional contractile disturbance and acute release of both catecholamines and NT-proBNP.
Original languageEnglish
Pages (from-to)1278-1284
Number of pages7
JournalHeart
Volume98
Issue number17
Early online date11 Jul 2012
DOIs
Publication statusPublished - Sep 2012

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Takotsubo Cardiomyopathy
Edema
Inflammation
Brain Natriuretic Peptide
Catecholamines
Normetanephrine
Left Ventricular Dysfunction
C-Reactive Protein
Coronary Artery Disease
Nitric Oxide
Blood Platelets

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Neil, C., Nguyen, T. H., Kucia, A., Crouch, B., Sverdlov, A., Chirkov, Y., ... Horowitz, J. (2012). Slowly resolving global myocardial inflammation/oedema in Tako-Tsubo cardiomyopathy: evidence from T2-weighted cardiac MRI. Heart, 98(17), 1278-1284. https://doi.org/10.1136/heartjnl-2011-301481

Slowly resolving global myocardial inflammation/oedema in Tako-Tsubo cardiomyopathy : evidence from T2-weighted cardiac MRI. / Neil, Christopher; Nguyen, Thanh Ha; Kucia, Angela; Crouch, Benjamin; Sverdlov, Aaron; Chirkov, Yuliy; Mahadavan, Gnanadevan; Selvanayagam, Joseph; Dawson, Dana; Beltrame, John; Zeitz, Christopher; Unger, Steven; Redpath, Thomas; Frenneaux, Michael; Horowitz, John.

In: Heart, Vol. 98, No. 17, 09.2012, p. 1278-1284.

Research output: Contribution to journalArticle

Neil, C, Nguyen, TH, Kucia, A, Crouch, B, Sverdlov, A, Chirkov, Y, Mahadavan, G, Selvanayagam, J, Dawson, D, Beltrame, J, Zeitz, C, Unger, S, Redpath, T, Frenneaux, M & Horowitz, J 2012, 'Slowly resolving global myocardial inflammation/oedema in Tako-Tsubo cardiomyopathy: evidence from T2-weighted cardiac MRI' Heart, vol. 98, no. 17, pp. 1278-1284. https://doi.org/10.1136/heartjnl-2011-301481
Neil, Christopher ; Nguyen, Thanh Ha ; Kucia, Angela ; Crouch, Benjamin ; Sverdlov, Aaron ; Chirkov, Yuliy ; Mahadavan, Gnanadevan ; Selvanayagam, Joseph ; Dawson, Dana ; Beltrame, John ; Zeitz, Christopher ; Unger, Steven ; Redpath, Thomas ; Frenneaux, Michael ; Horowitz, John. / Slowly resolving global myocardial inflammation/oedema in Tako-Tsubo cardiomyopathy : evidence from T2-weighted cardiac MRI. In: Heart. 2012 ; Vol. 98, No. 17. pp. 1278-1284.
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title = "Slowly resolving global myocardial inflammation/oedema in Tako-Tsubo cardiomyopathy: evidence from T2-weighted cardiac MRI",
abstract = "Objective Tako-Tsubo cardiomyopathy (TTC) is associated with regional left ventricular dysfunction, independent of the presence of fixed coronary artery disease. Previous studies have used T2-weighted cardiac MRI to demonstrate the presence of periapical oedema. The authors sought to determine the distribution, resolution and correlates of oedema in TTC.Patients 32 patients with TTC were evaluated at a median of 2 days after presentation, along with 10 age-matched female controls. Extent of oedema was quantified both regionally and globally; scanning was repeated in patients with TTC after 3 months. Correlations were sought between oedema and the extent of hypokinesis, catecholamine release, release of N-terminal prohormone of B-type natriuretic peptide (NT-proBNP), and markers of systemic inflammatory activation (high-sensitivity C-reactive protein and platelet response to nitric oxide).Results In the acute phase of TTC, T2-weighted signal intensity was greater at the apex than at the base (p<0.0001) but was nevertheless significantly elevated at the base (p<0.0001), relative to control values. Over 3 months, T2-weighted signal decreased substantially, but remained abnormally elevated (p<0.02). The regional extent of oedema correlated inversely with radial myocardial strain (except at the apex). There were also direct correlations between global T2-weighted signal and (1) plasma normetanephrine (r=0.39, p=0.04) and (2) peak NT-proBNP (r=0.39, p=0.03), but not with systemic inflammatory markers.Conclusions TTC is associated with slowly resolving global myocardial oedema, the acute extent of which correlates with regional contractile disturbance and acute release of both catecholamines and NT-proBNP.",
author = "Christopher Neil and Nguyen, {Thanh Ha} and Angela Kucia and Benjamin Crouch and Aaron Sverdlov and Yuliy Chirkov and Gnanadevan Mahadavan and Joseph Selvanayagam and Dana Dawson and John Beltrame and Christopher Zeitz and Steven Unger and Thomas Redpath and Michael Frenneaux and John Horowitz",
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doi = "10.1136/heartjnl-2011-301481",
language = "English",
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TY - JOUR

T1 - Slowly resolving global myocardial inflammation/oedema in Tako-Tsubo cardiomyopathy

T2 - evidence from T2-weighted cardiac MRI

AU - Neil, Christopher

AU - Nguyen, Thanh Ha

AU - Kucia, Angela

AU - Crouch, Benjamin

AU - Sverdlov, Aaron

AU - Chirkov, Yuliy

AU - Mahadavan, Gnanadevan

AU - Selvanayagam, Joseph

AU - Dawson, Dana

AU - Beltrame, John

AU - Zeitz, Christopher

AU - Unger, Steven

AU - Redpath, Thomas

AU - Frenneaux, Michael

AU - Horowitz, John

PY - 2012/9

Y1 - 2012/9

N2 - Objective Tako-Tsubo cardiomyopathy (TTC) is associated with regional left ventricular dysfunction, independent of the presence of fixed coronary artery disease. Previous studies have used T2-weighted cardiac MRI to demonstrate the presence of periapical oedema. The authors sought to determine the distribution, resolution and correlates of oedema in TTC.Patients 32 patients with TTC were evaluated at a median of 2 days after presentation, along with 10 age-matched female controls. Extent of oedema was quantified both regionally and globally; scanning was repeated in patients with TTC after 3 months. Correlations were sought between oedema and the extent of hypokinesis, catecholamine release, release of N-terminal prohormone of B-type natriuretic peptide (NT-proBNP), and markers of systemic inflammatory activation (high-sensitivity C-reactive protein and platelet response to nitric oxide).Results In the acute phase of TTC, T2-weighted signal intensity was greater at the apex than at the base (p<0.0001) but was nevertheless significantly elevated at the base (p<0.0001), relative to control values. Over 3 months, T2-weighted signal decreased substantially, but remained abnormally elevated (p<0.02). The regional extent of oedema correlated inversely with radial myocardial strain (except at the apex). There were also direct correlations between global T2-weighted signal and (1) plasma normetanephrine (r=0.39, p=0.04) and (2) peak NT-proBNP (r=0.39, p=0.03), but not with systemic inflammatory markers.Conclusions TTC is associated with slowly resolving global myocardial oedema, the acute extent of which correlates with regional contractile disturbance and acute release of both catecholamines and NT-proBNP.

AB - Objective Tako-Tsubo cardiomyopathy (TTC) is associated with regional left ventricular dysfunction, independent of the presence of fixed coronary artery disease. Previous studies have used T2-weighted cardiac MRI to demonstrate the presence of periapical oedema. The authors sought to determine the distribution, resolution and correlates of oedema in TTC.Patients 32 patients with TTC were evaluated at a median of 2 days after presentation, along with 10 age-matched female controls. Extent of oedema was quantified both regionally and globally; scanning was repeated in patients with TTC after 3 months. Correlations were sought between oedema and the extent of hypokinesis, catecholamine release, release of N-terminal prohormone of B-type natriuretic peptide (NT-proBNP), and markers of systemic inflammatory activation (high-sensitivity C-reactive protein and platelet response to nitric oxide).Results In the acute phase of TTC, T2-weighted signal intensity was greater at the apex than at the base (p<0.0001) but was nevertheless significantly elevated at the base (p<0.0001), relative to control values. Over 3 months, T2-weighted signal decreased substantially, but remained abnormally elevated (p<0.02). The regional extent of oedema correlated inversely with radial myocardial strain (except at the apex). There were also direct correlations between global T2-weighted signal and (1) plasma normetanephrine (r=0.39, p=0.04) and (2) peak NT-proBNP (r=0.39, p=0.03), but not with systemic inflammatory markers.Conclusions TTC is associated with slowly resolving global myocardial oedema, the acute extent of which correlates with regional contractile disturbance and acute release of both catecholamines and NT-proBNP.

U2 - 10.1136/heartjnl-2011-301481

DO - 10.1136/heartjnl-2011-301481

M3 - Article

VL - 98

SP - 1278

EP - 1284

JO - Heart

JF - Heart

SN - 1355-6037

IS - 17

ER -