Advertisement

Review of multi-modality imaging update and diagnostic work up of Takotsubo cardiomyopathy

Published:September 03, 2021DOI:https://doi.org/10.1016/j.clinimag.2021.08.027

      Highlights

      • Takotsubo cardiomyopathy (TC) is reversible syndrome mimicking acute coronary syndrome.
      • TC is typically characterized by basal hyperkinesis and apical akinesis.
      • Echocardiography and catheter angiography are often first line modality.
      • Cardiac MRI is modality of choice for the non-invasive initial assessment.
      • Cardiac MRI provides comprehensive evaluation for initial diagnosis and follow up.

      Abstract

      Takotsubo cardiomyopathy (TC) is an acute but reversible non-ischemic heart failure syndrome. It is characterized by a transient form of ventricular dysfunction typically manifesting as basal hyperkinesis with hypokinesia and ballooning of left ventricle mid-cavity and apex. Imaging helps in both diagnosis and follow up. Echocardiogram is the first-line modality to assess the typical contractile dysfunction in suspected patients with catheter angiography showing normal coronary arteries. Cardiac MRI is currently the modality of choice for the non-invasive initial assessment of TC and for follow up imaging. The current review focusses on historical background of TC, its pathophysiology, diagnostic work up and differential diagnosis and provides multimodality imaging work up of TC including role of echocardiogram, invasive catheterization, nuclear imaging, cardiac computed tomography and cardiac MRI including basic and advanced MRI sequences.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Clinical Imaging
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Sharkey S.W.
        • Lesser J.R.
        • Maron M.S.
        • Maron B.J.
        Why not just call it tako-tsubo cardiomyopathy: a discussion of nomenclature.
        J Am Coll Cardiol. 2011; 57: 1496-1497
        • Buchmann S.J.
        • Lehmann D.
        • Stevens C.E.
        Takotsubo cardiomyopathy-acute cardiac dysfunction associated with neurological and psychiatric disorders.
        Front Neurol. 2019; 10: 917
        • Murthy A.
        • Arora J.
        • Singh A.
        • Gedela M.
        • Karnati P.
        • Nappi A.
        Takotsubo cardiomyopathy: typical and atypical variants, a two-year retrospective cohort study.
        Cardiol Res. 2014; 5: 139-144
        • Izumo M.
        • Akashi Y.J.
        Role of echocardiography for takotsubo cardiomyopathy: clinical and prognostic implications.
        Cardiovasc Diagn Ther. 2018; 8: 90-100
        • Dote K.
        • Sato H.
        • Tateishi H.
        • Uchida T.
        • Ishihara M.
        Myocardial stunning due to simultaneous multivessel coronary spasms: a review of 5 cases.
        J Cardiol. 1991; 21: 203-214
        • Fernandez-Perez G.C.
        • Aguilar-Arjona J.A.
        • de la Fuente G.T.
        • Samartin M.
        • Ghioldi A.
        • Arias J.C.
        • et al.
        Takotsubo cardiomyopathy: assessment with cardiac MRI.
        AJR Am J Roentgenol. 2010; 195: W139-W145
        • Akashi Y.J.
        • Nef H.M.
        • Lyon A.R.
        Epidemiology and pathophysiology of takotsubo syndrome.
        Nat Rev Cardiol. 2015; 12: 387-397
        • Komamura K.
        • Fukui M.
        • Iwasaku T.
        • Hirotani S.
        • Masuyama T.
        Takotsubo cardiomyopathy: pathophysiology, diagnosis and treatment.
        World J Cardiol. 2014; 6: 602-609
        • Pelliccia F.
        • Kaski Juan C.
        • Crea F.
        • Camici Paolo G.
        Pathophysiology of takotsubo syndrome.
        Circulation. 2017; 135: 2426-2441
        • Manabe O.
        • Naya M.
        • Oyama-Manabe N.
        • Koyanagawa K.
        • Tamaki N.
        The role of multimodality imaging in takotsubo cardiomyopathy.
        J Nucl Cardiol. 2019; 26: 1602-1616
        • Milinis K.
        • Fisher M.
        Takotsubo cardiomyopathy: pathophysiology and treatment.
        Postgrad Med J. 2012; 88: 530-538
        • Pasupula D.K.
        • Patthipati V.S.
        • Javed A.
        • Siddappa Malleshappa S.K.
        Takotsubo cardiomyopathy: understanding the pathophysiology of selective left ventricular involvement.
        Cureus. 2019; 11e5972
        • Agarwal S.
        • Bean M.G.
        • Hata J.S.
        • Castresana M.R.
        Perioperative takotsubo cardiomyopathy: a systematic review of published cases.
        Semin Cardiothorac Vasc Anesth. 2017; 21: 277-290
        • Templin C.
        • Ghadri J.R.
        • Diekmann J.
        • Napp L.C.
        • Bataiosu D.R.
        • Jaguszewski M.
        • et al.
        Clinical features and outcomes of takotsubo (Stress) cardiomyopathy.
        N Engl J Med. 2015; 373: 929-938
        • Lyon A.R.
        • Bossone E.
        • Schneider B.
        • Sechtem U.
        • Citro R.
        • Underwood S.R.
        • et al.
        Current state of knowledge on takotsubo syndrome: a position statement from the taskforce on takotsubo syndrome of the heart failure Association of the European Society of cardiology.
        Eur J Heart Fail. 2016; 18: 8-27
        • Uribarri A.
        • Nunez-Gil I.J.
        • Conty D.A.
        • Vedia O.
        • Almendro-Delia M.
        • Duran Cambra A.
        • et al.
        Short- and long-term prognosis of patients with takotsubo syndrome based on different triggers: importance of the physical nature.
        J Am Heart Assoc. 2019; 8e013701
        • Eitel I.
        • von Knobelsdorff-Brenkenhoff F.
        • Bernhardt P.
        • Carbone I.
        • Muellerleile K.
        • Aldrovandi A.
        • et al.
        Clinical characteristics and cardiovascular magnetic resonance findings in stress (takotsubo) cardiomyopathy.
        JAMA. 2011; 306: 277-286
        • Mejía-Rentería H.D.
        • Núñez-Gil I.J.
        Takotsubo syndrome: advances in the understanding and management of an enigmatic stress cardiomyopathy.
        World J Cardiol. 2016; 8: 413-424
        • Zalewska-Adamiec M.
        • Bachorzewska-Gajewska H.
        • Tomaszuk-Kazberuk A.
        • Nowak K.
        • Drozdowski P.
        • Bychowski J.
        • et al.
        Takotsubo cardiomyopathy: serious early complications and two-year mortality - a 101 case study.
        Neth Heart J. 2016; 24: 511-519
        • Napp L.C.
        • Bauersachs J.
        Takotsubo syndrome: between evidence, myths, and misunderstandings.
        Herz. 2020; 45: 252-266
        • El-Battrawy I.
        • Santoro F.
        • Stiermaier T.
        • Möller C.
        • Guastafierro F.
        • Novo G.
        • et al.
        Incidence and clinical impact of recurrent takotsubo syndrome: results from the GEIST registry.
        J Am Heart Assoc. 2019; 8e010753
        • Boyd B.
        • Solh T.
        Takotsubo cardiomyopathy: review of broken heart syndrome.
        J Am Acad Physician Assist. 2020; 33: 24-29
        • Elesber A.A.
        • Prasad A.
        • Lennon R.J.
        • Wright R.S.
        • Lerman A.
        • Rihal C.S.
        Four-year recurrence rate and prognosis of the apical ballooning syndrome.
        J Am Coll Cardiol. 2007; 50: 448-452
        • Massobrio L.
        • Valbusa A.
        • Sartini M.
        • Meliota G.
        • Cavalla F.
        • Miceli R.
        • et al.
        Clinical characteristics and long-term mortality rate in female patients with takotsubo syndrome compared with female patients with ST-elevation acute myocardial infarction: a retrospective study from a single center.
        Cardiol Res Pract. 2019; 2019: 9156586
        • Stiermaier T.
        • Eitel C.
        • Denef S.
        • Desch S.
        • Schuler G.
        • Thiele H.
        • et al.
        Prevalence and clinical significance of life-threatening arrhythmias in takotsubo cardiomyopathy.
        J Am Coll Cardiol. 2015; 65: 2148-2150
        • Abe Y.
        • Kondo M.
        • Matsuoka R.
        • Araki M.
        • Dohyama K.
        • Tanio H.
        Assessment of clinical features in transient left ventricular apical ballooning.
        J Am Coll Cardiol. 2003; 41: 737-742
        • Bybee K.A.
        • Kara T.
        • Prasad A.
        • Lerman A.
        • Barsness G.W.
        • Wright R.S.
        • et al.
        Systematic review: transient left ventricular apical ballooning: a syndrome that mimics ST-segment elevation myocardial infarction.
        Ann Intern Med. 2004; 141: 858-865
        • Prasad A.
        • Lerman A.
        • Rihal C.S.
        Apical ballooning syndrome (Tako-tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction.
        Am Heart J. 2008; 155: 408-417
        • Kawai S.
        • Kitabatake A.
        • Tomoike H.
        Guidelines for diagnosis of takotsubo (ampulla) cardiomyopathy.
        Circ J. 2007; 71: 990-992
        • Segovia Cubero J.
        • Peraira Moral R.
        Transient apical ballooning syndrome: a transition towards adulthood.
        Rev Esp Cardiol. 2004; 57: 194-197
        • Redfors B.
        • Shao Y.
        • Lyon A.R.
        • Omerovic E.
        Diagnostic criteria for takotsubo syndrome: a call for consensus.
        Int J Cardiol. 2014; 176: 274-276
        • Wittstein I.S.
        Stress cardiomyopathy: a syndrome of catecholamine-mediated myocardial stunning?.
        Cell Mol Neurobiol. 2012; 32: 847-857
        • Parodi G.
        • Citro R.
        • Bellandi B.
        • Provenza G.
        • Marrani M.
        • Bossone E.
        Revised clinical diagnostic criteria for tako-tsubo syndrome: the tako-tsubo italian network proposal.
        Int J Cardiol. 2014; 172: 282-283
        • Madias J.E.
        Why the current diagnostic criteria of takotsubo syndrome are outmoded: a proposal for new criteria.
        Int J Cardiol. 2014; 174: 468-470
        • Ghadri J.-R.
        • Wittstein I.S.
        • Prasad A.
        • Sharkey S.
        • Dote K.
        • Akashi Y.J.
        • et al.
        International expert consensus document on takotsubo syndrome (Part I): clinical characteristics, diagnostic criteria, and pathophysiology.
        Eur Heart J. 2018; 39: 2032-2046
        • Kato K.
        • Kitahara H.
        • Fujimoto Y.
        • Sakai Y.
        • Ishibashi I.
        • Himi T.
        • et al.
        Prevalence and clinical features of focal takotsubo cardiomyopathy.
        Circ J. 2016; 80: 1824-1829
        • Ghadri J.R.
        • Cammann V.L.
        • Jurisic S.
        • Seifert B.
        • Napp L.C.
        • Diekmann J.
        • et al.
        A novel clinical score (InterTAK diagnostic Score) to differentiate takotsubo syndrome from acute coronary syndrome: results from the international takotsubo registry.
        Eur J Heart Fail. 2017; 19: 1036-1042
        • Ghadri J.-R.
        • Wittstein I.S.
        • Prasad A.
        • Sharkey S.
        • Dote K.
        • Akashi Y.J.
        • et al.
        International expert consensus document on takotsubo syndrome (Part II): diagnostic workup, outcome, and management.
        Eur Heart J. 2018; 39: 2047-2062
        • Di Filippo C.
        • Bacchi B.
        • Di Mario C.
        Novel aspects of classification, prognosis and therapy in takotsubo syndrome.
        Eur Cardiol. 2019; 14: 191-196
        • Gupta S.
        • Gupta M.M.
        Takotsubo syndrome.
        Indian Heart J. 2018; 70: 165-174
        • Kagiyama N.
        • Okura H.
        • Kume T.
        • Hayashida A.
        • Yoshida K.
        Isolated right ventricular takotsubo cardiomyopathy.
        Eur Heart J Cardiovasc Imaging. 2015; 16: 285
        • Stähli B.E.
        • Ruschitzka F.
        • Enseleit F.
        Isolated right ventricular ballooning syndrome: a new variant of transient cardiomyopathy.
        Eur Heart J. 2011; 32: 1821
        • Daoko J.
        • Rajachandran M.
        • Savarese R.
        • Orme J.
        Biventricular takotsubo cardiomyopathy: case study and review of literature.
        Tex Heart Inst J. 2013; 40: 305-311
        • Elesber A.A.
        • Prasad A.
        • Bybee K.A.
        • Valeti U.
        • Motiei A.
        • Lerman A.
        • et al.
        Transient cardiac apical ballooning syndrome: prevalence and clinical implications of right ventricular involvement.
        J Am Coll Cardiol. 2006; 47: 1082-1083
        • Kagiyama N.
        • Okura H.
        • Tamada T.
        • Imai K.
        • Yamada R.
        • Kume T.
        • et al.
        Impact of right ventricular involvement on the prognosis of takotsubo cardiomyopathy.
        Eur Heart J Cardiovasc Imaging. 2016; 17: 210-216
        • Duran-Cambra A.
        • Sutil-Vega M.
        • Fiol M.
        • Núñez-Gil I.J.
        • Vila M.
        • Sans-Roselló J.
        Systematic review of the electrocardiographic changes in the takotsubo syndrome.
        Ann Noninvasive Electrocardiol. 2015; 20: 1-6
        • Namgung J.
        Electrocardiographic findings in takotsubo cardiomyopathy: ECG evolution and its difference from the ECG of acute coronary syndrome.
        Clin Med Insights Cardiol. 2014; 8: 29-34
        • Castillo Rivera A.M.
        • Ruiz-Bailén M.
        • Rucabado Aguilar L.
        Takotsubo cardiomyopathy–a clinical review.
        Med Sci Monit. 2011; 17: RA135-RA47
        • Ahmed K.A.
        • Madhavan M.
        • Prasad A.
        Brain natriuretic peptide in apical ballooning syndrome (Takotsubo/stress cardiomyopathy): comparison with acute myocardial infarction.
        Coron Artery Dis. 2012; 23: 259-264
        • Gopalakrishnan P.
        • Zaidi R.
        • Sardar M.R.
        Takotsubo cardiomyopathy: pathophysiology and role of cardiac biomarkers in differential diagnosis.
        World J Cardiol. 2017; 9: 723-730
        • Budnik M.
        • Kochanowski J.
        • Piatkowski R.
        • Wojtera K.
        • Peller M.
        • Gaska M.
        • et al.
        Simple markers can distinguish takotsubo cardiomyopathy from ST segment elevation myocardial infarction.
        Int J Cardiol. 2016; 219: 417-420
        • Wittstein I.S.
        • Thiemann D.R.
        • Lima J.A.
        • Baughman K.L.
        • Schulman S.P.
        • Gerstenblith G.
        • et al.
        Neurohumoral features of myocardial stunning due to sudden emotional stress.
        N Engl J Med. 2005; 352: 539-548
        • Bossone E.
        • Lyon A.
        • Citro R.
        • Athanasiadis A.
        • Meimoun P.
        • Parodi G.
        • et al.
        Takotsubo cardiomyopathy: an integrated multi-imaging approach.
        Eur Heart J Cardiovasc Imaging. 2013; 15: 366-377
        • Parodi G.
        • Del Pace S.
        • Carrabba N.
        • Salvadori C.
        • Memisha G.
        • Simonetti I.
        • et al.
        Incidence, clinical findings, and outcome of women with left ventricular apical ballooning syndrome.
        Am J Cardiol. 2007; 99: 182-185
        • Napp L.C.
        • Cammann V.L.
        • Jaguszewski M.
        • Szawan K.A.
        • Wischnewsky M.
        • Gili S.
        • et al.
        Coexistence and outcome of coronary artery disease in takotsubo syndrome.
        Eur Heart J. 2020; 41: 3255-3268
        • Sharkey S.W.
        • Kalra A.
        • Henry T.D.
        • Smith T.D.
        • Pink V.R.
        • Lesser J.R.
        • et al.
        Coexistence of acute takotsubo syndrome and acute coronary syndrome.
        Catheter Cardiovasc Interv. 2020; 96: 825-829
        • Hausvater A.
        • Smilowitz N.R.
        • Saw J.
        • Sherrid M.
        • Ali T.
        • Espinosa D.
        • et al.
        Spontaneous coronary artery dissection in patients with a provisional diagnosis of takotsubo syndrome.
        J Am Heart Assoc. 2019; 8e013581
        • Hirose K.
        • Moriya M.
        • Ishiwata S.
        • Ohno M.
        A case of takotsubo cardiomyopathy that was confirmed by cardiac catheterization at all three times of onset.
        J Cardiol Cases. 2015; 12: 152-155
        • Citro R.
        • Lyon A.R.
        • Meimoun P.
        • Omerovic E.
        • Redfors B.
        • Buck T.
        • et al.
        Standard and advanced echocardiography in takotsubo (stress) cardiomyopathy: clinical and prognostic implications.
        J Am Soc Echocardiogr. 2015; 28: 57-74
        • Citro R.
        • Rigo F.
        • Ciampi Q.
        • D’Andrea A.
        • Provenza G.
        • Mirra M.
        • et al.
        Echocardiographic assessment of regional left ventricular wall motion abnormalities in patients with tako-tsubo cardiomyopathy: comparison with anterior myocardial infarction.
        Eur J Echocardiogr. 2011; 12: 542-549
        • Citro R.
        • Okura H.
        • Ghadri J.R.
        • Izumi C.
        • Meimoun P.
        • Izumo M.
        • et al.
        Multimodality imaging in takotsubo syndrome: a joint consensus document of the European Association of Cardiovascular Imaging (EACVI) and the Japanese Society of Echocardiography (JSE).
        J Echocardiogr. 2020; 18: 199-224
        • Izumo M.
        • Nalawadi S.
        • Shiota M.
        • Das J.
        • Dohad S.
        • Kuwahara E.
        • et al.
        Mechanisms of acute mitral regurgitation in patients with takotsubo cardiomyopathy: an echocardiographic study.
        Circ Cardiovasc Imaging. 2011; 4: 392-398
        • Liu K.
        • Carhart R.
        “Reverse McConnell’s Sign?”: a unique right ventricular feature of takotsubo cardiomyopathy.
        Am J Cardiol. 2013; 111: 1232-1235
        • Chockalingam A.
        • Xie G.Y.
        • Dellsperger K.C.
        Echocardiography in stress cardiomyopathy and acute LVOT obstruction.
        Int J Cardiovasc Imaging. 2010; 26: 527-535
        • Shaikh N.
        • Sardar M.
        • Jacob A.
        • Alagusundaramoorthy S.S.
        • Eng M.
        • Checton J.
        • et al.
        Possible predictive factors for recovery of left ventricular systolic function in takotsubo cardiomyopathy.
        Intractable Rare Dis Res. 2018; 7: 100-105
        • Abbara S.
        • Arbab-Zadeh A.
        • Callister T.Q.
        • Desai M.Y.
        • Mamuya W.
        • Thomson L.
        • et al.
        SCCT guidelines for performance of coronary computed tomographic angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee.
        J Cardiovasc Comput Tomogr. 2009; 3: 190-204
        • Ohta Y.
        • Kitao S.
        • Yunaga H.
        • Fujii S.
        • Mukai N.
        • Yamamoto K.
        • et al.
        Myocardial delayed enhancement CT for the evaluation of heart failure: comparison to MRI.
        Radiology. 2018; 288: 682-691
        • Scully P.R.
        • Bastarrika G.
        • Moon J.C.
        • Treibel T.A.
        Myocardial extracellular volume quantification by cardiovascular magnetic resonance and computed tomography.
        Curr Cardiol Rep. 2018; 20 (-): 15
        • Ko S.M.
        • Hwang S.H.
        • Lee H.J.
        Role of cardiac computed tomography in the diagnosis of left ventricular myocardial diseases.
        J Cardiovasc Imaging. 2019; 27: 73-92
        • Graça Santos L.
        • Dias Ferreira N.
        • Ladeiras-Lopes R.
        • Carvalho M.
        • Ferreira W.
        Dual-energy cardiac computed tomography: the “one-stop-shop” for acute myocarditis.
        Eur Heart J Cardiovasc Imaging. 2021; 22: 129
        • Hamilton-Craig C.R.
        • Tandon K.
        • Kwan B.
        • DeBoni K.
        • Burley C.
        • Wesley A.J.
        • et al.
        Coronary CT radiation dose reduction strategies at an australian tertiary care center - improvements in radiation exposure through an evidence-based approach.
        J Med Radiat Sci. 2020; 67: 25-33
        • Sabarudin A.
        • Sun Z.
        Coronary CT angiography: dose reduction strategies.
        World J Cardiol. 2013; 5: 465-472
        • Testa M.
        • Feola M.
        Usefulness of myocardial positron emission tomography/nuclear imaging in takotsubo cardiomyopathy.
        World J Radiol. 2014; 6: 502-506
        • Fro K.
        • Sugihara H.
        • Kinoshita N.
        • Azuma A.
        • Matsubara H.
        Assessment of Takotsubo cardiomyopathy (transient left ventricular apical ballooning) using99mTc-tetrofosmin,123I-BMIPP,123I-MIBG and99mTc-PYP myocardial SPECT.
        Ann Nucl Med. 2005; 19: 435-445
        • Cimarelli S.
        • Imperiale A.
        • Ben-Sellem D.
        • Rischner J.
        • Detour J.
        • Morel O.
        • et al.
        Nuclear medicine imaging of takotsubo cardiomyopathy: typical form and midventricular ballooning syndrome.
        J Nucl Cardiol. 2008; 15: 137
        • Villarroel A.H.
        • Vitola J.V.
        • Stier Jr., A.L.
        • Dippe Jr., T.
        • Cunha C.
        Takotsubo or stress cardiomyopathy: role of nuclear cardiology using (123)I-MIBG.
        Expert Rev Cardiovasc Ther. 2009; 7: 847-852
        • Matsuo S.
        • Nakajima K.
        • Kinuya S.
        • Yamagishi M.
        Diagnostic utility of 123I-BMIPP imaging in patients with takotsubo cardiomyopathy.
        J Cardiol. 2014; 64: 49-56
        • Kobylecka M.
        • Budnik M.
        • Kochanowski J.
        • Piatkowski R.
        • Chojnowski M.
        • Fronczewska-Wieniawska K.
        Takotsubo cardiomyopathy: FDG myocardial uptake pattern in fasting patients. Comparison of PET/CT, SPECT, and ECHO results.
        J Nucl Cardiol. 2018; 25: 1260-1270
        • Bratis K.
        Cardiac magnetic resonance in takotsubo syndrome.
        Eur Cardiol. 2017; 12: 58-62
        • Agewall S.
        • Beltrame J.F.
        • Reynolds H.R.
        • Niessner A.
        • Rosano G.
        • Caforio A.L.
        • et al.
        ESC working group position paper on myocardial infarction with non-obstructive coronary arteries.
        Eur Heart J. 2017; 38: 143-153
        • Vágó H.
        • Szabó L.
        • Dohy Z.
        • Czimbalmos C.
        • Tóth A.
        • Suhai F.I.
        • et al.
        Early cardiac magnetic resonance imaging in troponin-positive acute chest pain and non-obstructed coronary arteries.
        Heart (British Cardiac Society). 2020; 106: 992-1000
        • Rodriguez F.
        • Nathan A.S.
        • Navathe A.S.
        • Ghosh N.
        • Shah P.B.
        Serial classic and inverted pattern takotsubo cardiomyopathy in a middle-aged woman.
        Can J Cardiol. 2014; 301462.e7-9
        • Plácido R.
        • Cunha Lopes B.
        • Almeida A.G.
        • Rochitte C.E.
        The role of cardiovascular magnetic resonance in takotsubo syndrome.
        J Cardiovasc Magn Reson. 2016; 18: 68
        • Shaw E.
        • Tan Victoria L.C.
        • Ward M.
        • Figtree G.
        • Hamilton-Craig C.
        Takotsubo cardiomyopathy and left atrial function assessed by cardiac magnetic resonance imaging.
        J Am Coll Cardiol. 2015; 65A975-A
        • Garg P.
        • Swift A.J.
        • Zhong L.
        • Carlhäll C.-J.
        • Ebbers T.
        • Westenberg J.
        • et al.
        Assessment of mitral valve regurgitation by cardiovascular magnetic resonance imaging.
        Nat Rev Cardiol. 2020; 17: 298-312
        • Stiermaier T.
        • Lange T.
        • Chiribiri A.
        • Möller C.
        • Graf T.
        • Villnow C.
        • et al.
        Left ventricular myocardial deformation in takotsubo syndrome: a cardiovascular magnetic resonance myocardial feature tracking study.
        Eur Radiol. 2018; 28: 5160-5170
        • Friedrich M.G.
        • Sechtem U.
        • Schulz-Menger J.
        • Holmvang G.
        • Alakija P.
        • Cooper L.T.
        • et al.
        Cardiovascular magnetic resonance in myocarditis: a JACC white paper.
        J Am Coll Cardiol. 2009; 53: 1475-1487
        • Abdel-Aty H.
        • Zagrosek A.
        • Schulz-Menger J.
        • Taylor A.J.
        • Messroghli D.
        • Kumar A.
        • et al.
        Delayed enhancement and T2-weighted cardiovascular magnetic resonance imaging differentiate acute from chronic myocardial infarction.
        Circulation. 2004; 109: 2411-2416
        • Bohnen S.
        • Radunski U.K.
        • Lund G.K.
        • Kandolf R.
        • Stehning C.
        • Schnackenburg B.
        • et al.
        Performance of t1 and t2 mapping cardiovascular magnetic resonance to detect active myocarditis in patients with recent-onset heart failure.
        Circ Cardiovasc Imaging. 2015; 8
        • Aikawa Y.
        • Noguchi T.
        • Morita Y.
        • Tateishi E.
        • Kono A.
        • Miura H.
        • et al.
        Clinical impact of native T1 mapping for detecting myocardial impairment in takotsubo cardiomyopathy.
        Eur. Heart J. Cardiovasc. Imaging. 2019; 20: 1147-1155
        • Eitel I.
        • Lücke C.
        • Grothoff M.
        • Sareban M.
        • Schuler G.
        • Thiele H.
        • et al.
        Inflammation in takotsubo cardiomyopathy: insights from cardiovascular magnetic resonance imaging.
        Eur Radiol. 2010; 20: 422-431
        • Yuan W.-F.
        • Zhao X.-X.
        • Hu F.-B.
        • Bai C.
        • Tang F.
        Evaluation of early gadolinium enhancement (EGE) and cardiac functional parameters in cine-magnetic resonance imaging (MRI) on artificial intelligence in patients with acute myocarditis: a case-controlled observational study.
        Med Sci Monit. 2019; 25: 5493-5500
        • Aikawa Y.
        • Noguchi T.
        • Morita Y.
        • Yamada N.
        • Goto Y.
        • Ishihara M.
        • et al.
        Abstract 13432: Clinical significance of early gadolinium enhancement for detecting myocardial damage in patients with takotsubo cardiomyopathy.
        Circulation. 2013; 128A13432-A
        • Eitel I.
        • von Knobelsdorff-Brenkenhoff F.
        • Bernhardt P.
        • Carbone I.
        • Muellerleile K.
        • Aldrovandi A.
        • et al.
        Clinical characteristics and cardiovascular magnetic resonance findings in stress (Takotsubo) cardiomyopathy.
        JAMA. 2011; 306
        • Buckley O.
        • Madan R.
        • Kwong R.
        • Rybicki F.J.
        • Hunsaker A.
        Cardiac masses, part 1: imaging strategies and technical considerations.
        AJR Am J Roentgenol. 2011; 197: W837-W841
        • Rolf A.
        • Nef H.M.
        • Möllmann H.
        • Troidl C.
        • Voss S.
        • Conradi G.
        • et al.
        Immunohistological basis of the late gadolinium enhancement phenomenon in tako-tsubo cardiomyopathy.
        Eur Heart J. 2009; 30: 1635-1642
        • Sharkey S.W.
        • Windenburg D.C.
        • Lesser J.R.
        • Maron M.S.
        • Hauser R.G.
        • Lesser J.N.
        • et al.
        Natural history and expansive clinical profile of stress (tako-tsubo) cardiomyopathy.
        J Am Coll Cardiol. 2010; 55: 333-341
        • Bondarenko O.
        • Beek A.M.
        • Hofman M.B.
        • Kühl H.P.
        • Twisk J.W.
        • van Dockum W.G.
        • et al.
        Standardizing the definition of hyperenhancement in the quantitative assessment of infarct size and myocardial viability using delayed contrast-enhanced CMR.
        J Cardiovasc Magn Reson. 2005; 7: 481-485