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- Publisher
- Oxford University Press
- Copyright
- © The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.
- eISSN
- 2514-2119
- DOI
- 10.1093/ehjcr/ytab093
- Publisher site
- See Article on Publisher Site
Abstract
CARDIOVASCULAR FLASHLIGHT European Heart Journal - Case Reports doi:10.1093/ehjcr/ytab093 Cardiac imaging Global microvascular ischaemia following Takotsubo cardiomyopathy with left ventricular function recovery Amrit Chowdhary , Sharmaine Thirunavukarasu, Nick Jex , and Eylem Levelt* Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Worsley Building, Leeds LS2 9JT, UK Received 13 January 2021; first decision 29 January 2021; accepted 15 February 2021 An 86-year-old woman presented to hospital with worsening dys- and aVF (Figure 1A). Blood tests showed an elevated troponin I pnoea over the past 7 days. An admission 12-lead electrocardiogram of 10 612 ng/L (<57 ng/L) and N-terminal pro B-type natriuretic pep- showed ST-elevation with T-wave inversion in leads V2–V6, I, II, III, tide of 34 811 ng/L (<34 ng/L). Transthoracic echocardiogram Figure 1 (A) An admission 12-lead electrocardiogram showing ST-elevation with T-wave inversion across leads V2–V6, I, II, III, and aVF. (B)End- diastolic four-chamber transthoracic echocardiogram view at admission. (C) End-systolic four-chamber transthoracic echocardiogram view at admis- sion. (D) Four-chamber cardiovascular magnetic resonance late-gadolinium enhanced left ventricular mid-slice showing absence of fibrosis or myo- cardial infarction. (E) Short-axis cardiovascular magnetic resonance late-gadolinium enhanced left ventricular mid-slice showing absence of fibrosis in the area of the perfusion defect. (F) Basal left ventricular short-axis cardiovascular magnetic resonance perfusion slice showing marked subendocar- dial circumferential perfusion defect, with (G) corresponding cardiovascular magnetic resonance quantitative perfusion map demonstrating subendo- cardial circumferential hypoperfusion. * Corresponding author. Tel: þ44 (0) 113 343, Email: e.levelt@leeds.ac.uk Handling Editor: Francesca Musella V The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestrict- ed reuse, distribution, and reproduction in any medium, provided the original work is properly cited. 2 A. Chowdhary et al. demonstrated left ventricular ejection fraction of 35% with akinesis Retrospectively, a diagnosis of Takotsubo cardiomyopathy with of the mid-anterior, mid-septal, and all apical segments (Figure 1B and CMD was made. Supporting this, the patient with hindsight reported C). A diagnosis of late anterior ST-elevation myocardial infarction was a preceding stressor: her wallet being stolen on the day of admission. made and given the low likelihood of clinical benefit with revasculari- zation, she was medically managed. At 8-week outpatient review, she reported worsening dyspnoea Supplementary material and atypical chest pain. An adenosine stress cardiovascular magnetic Supplementary material is available at European Heart Journal - Case resonance scan (CMR) was performed which revealed normal bi- Reports online. ventricular size and function, no regional wall motion abnormalities, and no myocardial scar on late gadolinium-enhanced imaging (Figure . Slide sets: A fully edited slide set detailing this case and suitable for 1D and E). Adenosine stress perfusion imaging demonstrated marked local presentation is available online as Supplementary data. circumferential perfusion defects with a globally reduced myocardial . Consent: The authors confirm that written consent for submission blood flow at stress of 1.21 mL/g/min (Figure 1E and F). Subsequently, . and publication of this case report including images and associated an invasive coronary angiogram was performed, which revealed . mild–moderate stenosis in the left anterior descending artery only. In text has been obtained from the patient in line with COPE guidance. the absence of significant epicardial coronary artery stenosis, the per- Conflict of interest: None declared. fusion defects on CMR may be due to coronary microvascular dys- function (CMD). Funding: None declared.
Journal
European Heart Journal - Case Reports – Oxford University Press
Published: Mar 10, 2021