Stress cardiomyopathy MRI: Difference between revisions

	Stress cardiomyopathy Microchapters
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Revision as of 23:06, 7 January 2017

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

MRI

Cardiac Magnetic Resonance (CMR)

Cardiac magnetic resonance (CMR) is a useful imaging modality in distinguishing between stress cardiomyopathy and myocarditis or MI. In the case of myocarditis or MI, there is delayed hyper-enhancement of gadolinium. However, absence of gadolinium hyper-enhancement supports the diagnosis of stress cardiomyopathy. Also, stress cardiomyopathy results in regional wall abnormality and its extent can best be documented using cardiac magnetic resonance.

MRI Examples

The MRIs below show a patients heart with apical ballooning and then later after resolution of the apical ballooning.

MRI during apical balllooning: {{#ev:youtube|23w6f71zTXI}} ____

MRI following resolution of apical ballooning: {{#ev:youtube|qE0YrlQ5d1o}}

References

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 ==Overview==
 ==MRI==
-The use of [[Magnetic resonance imaging|MRIs]] as a valuable diagnostic tool in differentiating cardiomyopathy from acute [[myocardial infarction]] and [[myocarditis]] cases.  Cardiac magnetic resonance imaging is helpful in excluding a [[myocardial infarction]] due to the absence of delayed gadolinium hyperenhancement.
-The Eitel study is the largest (n=256), (multi-center) cardiovascular MRI imaging series of stress cardiomyopathy <ref>Eitel I, von Knobelsdorff-Brekenhoff F, Bernhardt P, et al. Clinical characteristics and CV magnetic resonance findings in stress (Takotsubo) cardiomyopathy. JAMA 2011; 306:277-286.</ref>.  Stress cardiomyopathy can be accurately diagnosed by identifying a typical pattern of LV dysfunction, [[myocardial edema]], absence of significant necrosis/fibrosis, and markers of myocardial inflammation.  There are four distinct patterns of regional ventricular ballooning: apical (82%), biventricular (34%), midventricular (17%), and basal (1%).  Because patients with [[Right ventricle|RV]] involvement tended to be older, hospitalized for longer, and have markers of heart failure, biventricular ballooning on MRI “may portend a longer and more severe course of disease compared with patients with isolated [[Left ventricle|(LV)]] involvement.” Dysfunctions in the right ventricle are important to identify due to its effects on morbidity, treatment, and outcome.  During follow up MRIs, patients exhibited normalization of [[Ejection fraction|LVEF]] (66%) and inflammatory markers in the absence of significant fibrosis in all patients.
+=== Cardiac Magnetic Resonance (CMR) ===
+[[Cardiovascular magnetic resonance imaging (CMR)|Cardiac magnetic resonance (CMR)]] is a useful imaging modality in distinguishing between stress cardiomyopathy and [[myocarditis]] or [[MI]]. In the case of [[myocarditis]] or [[MI]], there is delayed hyper-enhancement of [[gadolinium]]. However, absence of [[gadolinium]] hyper-enhancement supports the diagnosis of stress cardiomyopathy. Also, stress cardiomyopathy results in regional wall abnormality and its extent can best be documented using [[Cardiovascular magnetic resonance imaging (CMR)|cardiac magnetic resonance]].
 ====MRI Examples====