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European Heart Journal Advance Access originally published online on April 23, 2009
European Heart Journal 2009 30(13):1635-1642; doi:10.1093/eurheartj/ehp140
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Immunohistological basis of the late gadolinium enhancement phenomenon in tako-tsubo cardiomyopathy

Andreas Rolf1,*,{dagger}, Holger M. Nef1,{dagger}, Helge Möllmann1, Christian Troidl2, Sandra Voss2, Guido Conradi1, Johannes Rixe1, Holger Steiger1, Katharina Beiring1, Christian W. Hamm1 and Thorsten Dill1

1 Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany
2 Max-Planck-Institute for Heart and Lung Research, Bad Nauheim, Germany

Received 1 October 2008; revised 6 February 2009; accepted 13 March 2009; online publish-ahead-of-print 23 April 2009.

* Corresponding author. Tel: +49 6032 996 2461, Fax: +49 6032 996 2848, Email: a.rolf{at}kerckhoff-klinik.de

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/µm2; LGE negative: 7.57, IQR 5.41–9.19 AU/µm2, 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.

Key Words: Late gadolinium enhancement • Fibrosis • Cardiac magnetic resonance imaging • Apical ballooning • Tako-tsubo cardiomyopathy • Stress cardiomyopathy

{dagger} Both authors contributed equally to this work.


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