Late Gadolinium Enhancement in Takotsubo Syndrome: Mechanism and Its Clinical Significance

Takotsubo syndrome (TS) is an acute and reversible form of myocardial dysfunction characterized by distinctive left ventricular (LV) wall motion abnormalities that typically extend beyond the distribution of a single epicardial coronary artery. Cardiovascular magnetic resonance (CMR) has emerged as a key non-invasive imaging modality for the evaluation of TS, offering a comprehensive assessment of myocardial function and tissue characterization. Among CMR techniques, late gadolinium enhancement (LGE) is a cornerstone for the diagnosis and risk stratification of various cardiopathies, primarily identifying areas of myocardial fibrosis or expansion of the interstitial space. In TS, the typical CMR profile includes myocardial edema in the absence of corresponding LGE, a finding often used to support the diagnosis. However, emerging evidence has reported the presence of LGE in a subset of TS patients, raising questions about its prevalence, underlying mechanisms, and clinical significance. This narrative review aims to explore current evidence on LGE in TS, examining its pathophysiological basis, diagnostic value, and potential prognostic implications.