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With great interest, we read the article by Rolf et al. 1 The histological basis of late gadolinium enhancement (LGE) in magnetic resonance imaging (MRI) was examined in 15 patients with transient ventricular ballooning or the so-called Tako-Tsubo syndrome. While all patients exhibited increased collagen-1 in endomyocardial biopsies, it was higher in five patients who showed LGE. After 14 days, LGE and collagen-1 normalized. Since focal LGE pattern did not match the areas of increased collagen that were diffusely spread over the left ventricle, collagen-1 alone cannot explain the occurrence of LGE.We agree that an increase of the interstitial space …

Occurrence of late gadolinium enhancement in ventricular ballooning or Tako-Tsubo syndrome: increased wall stress should not be overlooked