Manganese-Enhanced Magnetic Resonance Imaging in Takotsubo Syndrome

T. Singh, S. Joshi, L.E. Kershaw, A.H. Baker, G.P. Mccann, D.K. Dawson, M.R. Dweck, S.I. Semple, D.E. Newby

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Takotsubo syndrome is an acute cardiac emergency characterized by transient left ventricular systolic dysfunction typically following a stressful event. Despite its rapidly rising incidence, its pathophysiology remains poorly understood. Takotsubo syndrome may pass unrecognized, especially if timely diagnostic imaging is not performed. Defective myocardial calcium homeostasis is a central cause of contractile dysfunction and has not been explored in takotsubo syndrome. We aimed to investigate myocardial calcium handling using manganese-enhanced magnetic resonance imaging during the acute and recovery phases of takotsubo syndrome.

Twenty patients with takotsubo syndrome (64±12 years of age; 90% female) and 20 volunteers matched on age, sex, and cardiovascular risk factors (59±11 years of age; 70% female) were recruited from the Edinburgh Heart Centre between March 2020 and October 2021. Patients underwent gadolinium and manganese-enhanced magnetic resonance imaging during index hospitalization with repeat manganese-enhanced magnetic resonance imaging performed after at least 3 months.

Compared with matched control volunteers, patients had a reduced left ventricular ejection fraction (51±11 versus 67±8%; P
In patients with takotsubo syndrome, there is a profound perturbation of myocardial manganese uptake, which is most marked in the acute phase but persists for at least 3 months despite apparent restoration of normal left ventricular ejection fraction and resolution of myocardial edema, suggesting abnormal myocardial calcium handling may be implicated in the pathophysiology of takotsubo syndrome. Manganese-enhanced magnetic resonance imaging has major potential to assist in the diagnosis, characterization, and risk stratification of patients with takotsubo syndrome.
Original languageEnglish
Pages (from-to)1823-1835
Issue number24
Publication statusPublished - 1 Nov 2022

Keywords / Materials (for Non-textual outputs)

  • Aged
  • Calcium
  • Female
  • Humans
  • Magnetic Resonance Imaging
  • Magnetic Resonance Imaging, Cine/methods
  • Male
  • Manganese
  • Middle Aged
  • Stroke Volume
  • Takotsubo Cardiomyopathy/diagnostic imaging
  • Ventricular Function, Left/physiology


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