Cardiac MRI studies of transient left ventricular apical ballooning syndrome (takotsubo cardiomyopathy): A systematic review

Abstract 

Background

Since its first description in 1991, many cases of transient left ventricular apical ballooning syndrome (TLVABS) have been described, but the use of cardiac MRI in this condition is much more recent.

Methods and results

We performed a systematic review of the present literature in the MEDLINE and EMBASE databases for relevant case series of TLVABS (≥5 reported original cases, MRI analysis in the acute phase) and summarized the main results in a narrative synthesis. Only 8 studies met the eligible criteria, counting 176 patients (women: 95%; age: 68, stress trigger: 80%). MRI assessed an improvement of mean left ventricular ejection fraction from 39 (in the acute phase) to 64% (in the recovery phase). A right ventricular dysfunction was reported in 38%, a myocardial oedema in 81% and an apical thrombus in 5%.

Conclusions

Although cardiac MRI is a very useful and inescapable tool in the management of TLVABS, there is no large published study concerning this topic. A systematic and multicentric register of TLVABS studied by cardiac MRI is necessary.

Keywords: Cardiac MRI, Transient left ventricular apical ballooning syndrome, Takotsubo cardiomyopathy, Left ventricular dysfunction