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doi:10.1093/ehjci/jev167 Online publish-ahead-of-print 9 July 2015

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Multiparametric relaxometry by cardiac magnetic resonance imaging in Takotsubo cardiomyopathy Pankaj Garg, John P. Greenwood, and Sven Plein* Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds LS2 9JT, UK

* Corresponding author. Tel: +44 113 3437720; Fax: +44 113 3436603, E-mail: [email protected]

Supplementary data are available at European Heart Journal – Cardiovascular Imaging online. Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2015. For permissions please email: [email protected]

Downloaded from http://ehjcimaging.oxfordjournals.org/ at University of Pennsylvania Library on September 26, 2015

A 67-year-old female with a history of recent bereavement was admitted with acute-onset chest pain and global ST-segment changes. She underwent emergency coronary angiography, which demonstrated no flow-limiting coronary arterial disease. Cardiovascular magnetic resonance (CMR) was performed on day 1 and included the following pulse sequences: cines, native-T1 mapping (Modified Look Locker Inversion recovery) and T2-weighted imaging, early and late gadolinium enhancement (LGE) imaging and 15-min postcontrast T1-mapping. Cine images showed akinesia of the mid-apical anterior and anteroseptal segments and the apex with preserved contractility at the base (see Supplementary data online, Video S1). T2-weighted imaging demonstrated corresponding high signal suggestive of myocardial oedema (Panels 1a – c). Native-T1 maps (Panels 2a – c, using cut-off of 1000 ms) and extra-cellular volume (ECV) maps (Panels 3a –c, using cut-off of 29%) demonstrated high native-T1 and mildly raised ECV in the same segments. LGE imaging (Panels 4a– c) showed no evidence of infarction. On the basis of the clinical history, coronary angiogram, and CMR findings, a diagnosis of Takotsubo cardiomyopathy (TC) was made. Although the abnormalities on CMR affected mainly the left anterior descending coronary artery territory, this pattern of injury has been described in TC. This case demonstrates the potential benefit of parametric mapping in routine CMR. Conventionally used T2-weighted images for myocardial oedema suffer from spatial heterogeneity and are qualitative. As shown in this case, T1-mapping and the derived ECV are quantitative measurements that can detect and quantify myocardial changes in TC. In this case, native-T1 map was particularly useful, presumably as it is more sensitive to oedema than ECV mapping.

Multiparametric relaxometry by cardiac magnetic resonance imaging in Takotsubo cardiomyopathy.

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