Cardiovascular magnetic resonance characteristics of focal takotsubo syndrome.

AIMS: Focal takotsubo syndrome (TTS) is rare, and limited data are available on its cardiovascular magnetic resonance (CMR) characteristics. We aimed to define CMR characteristics and disease patterns of focal TTS.

METHODS AND

RESULTS

Patients with suspected TTS referred for CMR between 2008 and 2024 were retrospectively evaluated. Clinical, laboratory, and coronary angiography data were analyzed. CMR assessment included regional wall motion abnormalities (RWMA), myocardial edema, and late gadolinium enhancement (LGE). Follow-up data was retrieved. After exclusion of 442 patients, 30 patients with focal TTS were identified (67 ± 17 years; 27 females). Initial presentation resembled those typical of TTS (i.e., acute chest pain 15/30 [50 %], emotional or physical trigger 14/30 [47 %]). On CMR, focal RWMA and myocardial edema, predominantly in the anterior wall (RWMA 29/30 [97 %], edema 29/30 [97 %]) was present; involvement of the inferior wall was rare (RWMA 1/30 [3 %], edema 2/30 [7 %]). In affected segments, diffuse LGE was present in 4/30 patients (13 %). High signal intensity LGE (i.e., focal scarring) was not observed. Follow-up CMR data was available in 10/30 (33 %) patients and showed complete resolution of edema in all patients and a decreased median number of segments with RWMA (3.5 [interquartile range, IQR: 2-5.25] vs. 1 [IQR: 0-2] vs; p = 0.007).

CONCLUSION

CMR revealed a distinctive pattern of transient RWMA and myocardial edema in focal TTS, primarily affecting the anterior segments, suggesting that it may be classified as "anterior" TTS. Given its clinical similarity to typical TTS and other differential diagnoses, CMR is crucial for accurate diagnosis.