The Authors Reply: Right ventricle involvement in Tako-Tsubo cardiomyopathy

We thank Drs. Chhabra and Chaubrey for their interest in our publication (1) and for the questions they raised, which are a natural extension of our reported investigation. We can confirm that we indeed observed abnormalities in the right ventricle (RV) in our cohort of patients with Tako-tsubo cardiomyopathy. The word count constraints of a “letter to the editor” prevented us from elaborating beyond the findings of myocardial edema and profoundly altered cardiac energetics in the left ventricle and incomplete recovery of both at 4 months’ follow-up—which were the novelties in our report that move the field forward. We recently reported the preliminary RV findings in abstract form at the SCMR/EuroCMR Joint Scientific Sessions (February 4 to 7, 2015; Nice, France). However, with regard to 31P-magnetic resonance spectroscopy of the RV, it is difficult to achieve with current technology and has so far been reported only once, specifically in RVs that demonstrated significant hypertrophy (2). By comparison, in our patients, the RV wall was thinner. Furthermore, the basal part of the RV has significant motion during the cardiac cycle and the RV is generally very trabeculated, which would result in significant blood contamination if a voxel of interest were to be placed in the RV wall. If all of these constraints were surmountable, a separate acquisition time would also have to be dedicated, which would prolong the scan time further. For all of these reasons, we have not attempted to acquire 31P spectra for quantification of cardiac energetics of the RV at this stage. However, we agree that this would be a fascinating avenue of exploration, which we hope to look into in the future.