Cardiac MR imaging should be performed in elderly patients with acute chest pain to rule out Tako-Tsubo cardiomyopathy, also known as broken heart syndrome. The test could spare them a trip to the cath lab.
Staff radiologist Dr. Bernd Cornelius described at the 2006 RSNA meeting the unique cardiac MR signature of Tako-Tsubo syndrome based on experience with cases at the Hospital of the City of Ludwighafen am Rhein in Germany. Seven elderly women arrived at the hospital's emergency room with acute chest pain and ECG changes. Troponin T enzyme was elevated in five cases. Emergency percutaneous coronary angiography was negative in all cases, leading to referrals to cardiac MRI.
Cardiac MRI, including wall motion, first-pass perfusion, and delayed-enhancement sequences, was performed two to five days after onset of symptoms. By analyzing delayed-enhancement images, Cornelius found that the myocardium appeared more gray than white in the area of left ventricular apical ballooning and edema, characteristic of the syndrome. The pathology was most easily appreciated on the long-axis images. The grayish presentation did not appear in cardiac MR studies of 66 patients who did not have broken heart syndrome despite fitting the social profile of the disease.
The ability to rule out myocardial infarction and myocarditis using the cardiac MR indicator is important, according to Cornelius, because it potentially spares elderly patients invasive catheterization and other diagnostic procedures. The study suggested to him that cardiac MRI should be performed before invasive angiography to screen for Tako-Tsubo cardiomyopathy.
The prognosis for patients with broken heart syndrome is good. Symptoms, including depressed left ventricular output, disappear without treatment within two weeks.
Though Tako-Tsubo cardiomyopathy is classified as rare, incidence has increased. Two radiologists who attended Cornelius's presentation had seen patients with the characteristic delayed-enhancement pattern of Tako-Tsubo in the previous two weeks.
For more information from the Diagnostic Imaging archives:
Consensus remains elusive for best left ventricle test
MR imaging obtained during systole freeze coronaries
