Late gadolinium enhancement does occur in Tako-tsubo cardiomyopathy — a quantitative cardiac magnetic resonance and speckle tracking strain study

Background Late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR) has been recommended to distinguish Tako-tsubo cardiomyopathy (TTC) from either acute myocardial infarction or myocarditis. Method 44 consecutive patients with confirmed Mayo Clinic criteria for TTC underwent CMR imaging at 1.5\ua0Tesla during the acute phase. 10 patients who had CMRI to exclude scar related ventricular tachycardia, and had negative studies, were used as negative controls. LGE was quantitated at two signal intensity thresholds (CircleCVi software) at >\ua02 and >\ua05 standard-deviations (SD) above reference myocardium, and compared to biomarkers. Findings Mean door-to-CMR time was 57\ua0hours. 18 patients (41%) had LGE >\ua02 SD localized to the area of abnormal wall motion, representing 28.9\ua0±\ua011.2% LV mass. In 16 of these 18 patients (89%) LGE signal intensity was >\ua05 SD above normal myocardium, representing 12.1\ua0±\ua010% LV mass. LGE signal intensity was significantly greater in TTC than in matched controls (p\ua