Scally C, et al. - Whether inflammation is key to the pathophysiology and natural history of takotsubo cardiomyopathy was investigated in this multicenter study which involved 55 prospectively selected patients with takotsubo cardiomyopathy and 51 age-, sex-, and comorbidity-matched control subjects. For identifying inflammatory macrophages in the myocardium, researchers performed multiparametric cardiac magnetic resonance imaging, including ultrasmall superparamagnetic particles of iron oxide (USPIO) enhancement in patients with takotsubo cardiomyopathy during the index event and at the 5-month follow-up. Systemic inflammation was detected by assessing blood monocyte subpopulations and serum cytokines. Greater USPIO enhancement in both ballooning and nonballooning left ventricular myocardial segments was detected among patients vs controls. A myocardial macrophage inflammatory infiltrate, alterations in the distribution of monocyte subsets, and an increase in systemic proinflammatory cytokines were identified as the characteristics of takotsubo cardiomyopathy, and this was discovered for the first time. A low-grade chronic inflammatory state was indicated by the observed persistence of many of these changes for at least 5 months.