The Detection Rate of Late Gadolinium Enhancement in Takotsubo Syndrome: A Systematic Review and Meta-Analysis

: Absence of late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) is commonly used to distinguish takotsubo syndrome (TTS) from other myocardial diseases. However, case series have reported the presence of LGE in TTS. The present study aimed to summarize the evidence on the frequency of LGE in TTS and identify potential variables that may influence the detection of LGE. Electronic databases were systematically searched for studies reporting LGE frequency in TTS patients. The overall frequency was estimated using the inverse variance method and a random-effect model for single proportion. Factors influencing LGE detection were analyzed. Among 490 studies screened, 21 were included (703 patients, 90% female). The estimated overall frequency of LGE was 22.4% (95% CI 8.7-39.6%). Among TTS patients who underwent CMR within three days of symptom occurrence, the frequency of LGE was 40.7% (95% CI 18.8-64.5%), significantly higher than among those who performed CMR after three days (3.9%, p<0.010). The sensitivity threshold used in the imaging protocols had a statistically significant impact on the frequency of LGE detection (p=0.030). Ten studies performed a follow-up CMR after at least three months, reporting a frequency of LGE of 1.7 % (95% CI 0.0-8.9%). In conclusion, published studies report the presence of LGE in TTS at presentation among a significant proportion of patients. However, its detection is strongly influenced by the duration between symptom onset and CMR acquisition, and by the sensitivity threshold used for the imaging protocol. LGE is rarely present at follow-up.