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• Clinical Article •
Cardiac magnetic resonance tissue characteristics and their association with systemic inflammation in acute Takotsubo cardiomyopathy: A longitudinal quantitative study
ZHANG Shuang  XIN Ruiqiang  HAO Yi  PENG Ruchen  LI Yancui  ZHANG Ling  ZHONG Jiali  YANG Haiping 

DOI:10.12015/issn.1674-8034.2026.07.008.


[Abstract] Objective To systematically evaluate whether acute Takotsubo cardiomyopathy is accompanied by both myocardial tissue-level inflammatory changes and systemic inflammatory activation, and to investigate their correspondence and temporal evolution using cardiac magnetic resonance (CMR) tissue characterization combined with serum cytokine profiling.Materials and Methods Forty-two patients with acute Takotsubo cardiomyopathy and 29 healthy controls were enrolled. All participants underwent CMR with acquisition of native T1 mapping, native T2 mapping, and extracellular volume (ECV) for myocardial tissue characterization, along with left ventricular functional assessment. Patients received follow-up CMR at 3 and 6 months. Concurrent measurements included cardiac injury biomarkers, NT-proBNP, and multiple cytokines (IL-1β, IL-6, IL-8, IL-10, MCP-1, TNF-α, IFN-γ). Acute-phase and follow-up changes in tissue parameters and inflammatory markers were compared, and correlations between acute values and longitudinal changes were analyzed.Results Patients in the acute phase exhibited significantly elevated native T1 and T2 (both P < 0.05), indicating diffuse myocardial edema, with the largest increases observed in ballooning segments. Both T1 and T2 declined significantly during recovery (both P < 0.05), although ECV remained elevated at 6 months in a subset of patients. Left ventricular ejection fraction improved over time, accompanied by reductions in end-systolic volume index and myocardial mass index (both P < 0.01). IL-6, IL-8, and MCP-1 were elevated in the acute phase, and their declines showed moderate positive correlations with improvements in T1/T2 (all P < 0.05), indicating parallel changes between myocardial abnormalities and systemic inflammation with temporal correspondence during recovery. TNF-α, IFN-γ, and IL-10 did not rise acutely and remained stable throughout follow-up, suggesting a non-necrotic and non-severe inflammatory phenotype in Takotsubo cardiomyopathy.Conclusions Acute Takotsubo cardiomyopathy is characterized by marked myocardial edema and elevations in proinflammatory cytokines. Although most imaging and inflammatory abnormalities improve during the recovery phase, residual structural alterations persist in some patients, indicating that inflammation-related myocardial injury may not be fully reversible. Accordingly, CMR combined with cytokine profiling provides valuable tools for assessing myocardial edema, changes in quantitative tissue parameters, and inflammatory responses, as well as for dynamically tracking the recovery process in Takotsubo cardiomyopathy.
[Keywords] Takotsubo cardiomyopathy；cardiac magnetic resonance imaging；myocardial inflammation；systemic inflammatory response；T1/T2 mapping；inflammatory cytokines；extracellular volume

ZHANG Shuang   XIN Ruiqiang*   HAO Yi   PENG Ruchen   LI Yancui   ZHANG Ling   ZHONG Jiali   YANG Haiping  

Department of Radiology, Beijing Luhe Hospital, Capital Medical University, Beijing 101100, China

Corresponding author: XIN R Q, E-mail: rxin@ccmu.edu.cn

Conflicts of interest   None.

Received  2026-03-10
Accepted  2026-07-12
DOI: 10.12015/issn.1674-8034.2026.07.008
DOI:10.12015/issn.1674-8034.2026.07.008.

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