April 23, 2009European Heart Journal140 citationsOpen Access
View Full PaperImmunohistological basis of the late gadolinium enhancement phenomenon in tako-tsubo cardiomyopathy
Structured PICO
What is the histological basis of late gadolinium enhancement in patients with tako-tsubo cardiomyopathy?
P
Population
15 patients with tako-tsubo cardiomyopathy diagnosed by coronary angiography and ventriculography.
I
Intervention
Cardiac MRI within 24 h of admission and endomyocardial biopsies during acute phase and after recovery.
C
Comparator
LGE negative patients and control tissue.
O
Outcome
Content of fibrosis determined by immunohistochemical staining of collagen-1.surrogate
Late gadolinium enhancement in tako-tsubo cardiomyopathy is associated with a disproportionate, reversible increase in extracellular matrix (collagen-1) rather than irreversible fibrosis.
Abstract
AIMS: Tako-tsubo cardiomyopathy is characterized by transient contractile dysfunction after emotional or physical stress. Only few patients show late gadolinium enhancement (LGE) in cardiovascular magnetic resonance imaging (MRI). It was the purpose of this study to elucidate the histological basis of this phenomenon. METHODS AND RESULTS: The study included 15 patients. Tako-tsubo cardiomyopathy was diagnosed by coronary angiography and ventriculography. Cardiac MRI was performed within 24 h of admission. Endomyocardial biopsies were taken during the acute phase and after recovery. The content of fibrosis was determined by immunohistochemical staining of collagen-1. In the acute phase, cardiac MRI revealed LGE in five patients. This was completely reversed at follow-up 14, inter-quartile range (IQR) 11-14.5 days. All patients showed a significant increase of collagen-1 compared with control tissue. Moreover, the amount of collagen-1 was significantly higher in LGE positive patients (LGE positive: 18.84, IQR 13.82-19.75 AU/microm(2); LGE negative: 7.57, IQR 5.41-9.19 AU/microm(2), P = 0.001). The presence of LGE was not associated with poorer left ventricular function. CONCLUSION: The presence of LGE cannot rule out tako-tsubo cardiomyopathy. Instead it defines a special subgroup of patients with a disproportionate increase of extracellular matrix.