123I-MIBG myocardial scintigraphy in patients with reversible ventricular dysfunction Takotsubo cardiomyopathy

Akashi, Yoshihiro; Musha, Haruki; Kida, Kenji; Itoh, Kae; Inoue, Kentaro; Kawasaki, K.; Hashimoto, Nobuyuki; Nakazawa, Kiyoshi; Miyake, Fumihiko

doi:10.1016/j.nuclcard.2004.12.019

Cited by 121 publications

(195 citation statements)

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“…It seems to be more frequent in women of post menopausal age [2] but the exact prevalence is unknown. Akashi and colleagues found that the prevalence of TC in their institution was around 2% [3] similar to what Bybee and co-workers reported [4]. New cases of TC are reported every year around the world and nuclear medicine techniques have been used in evaluation of several of these cases.…”

Section: Introductionsupporting

confidence: 58%

Scintigraphic Evaluation of Takotsubo Cardiomyopathy

Lalude¹,

Gutarra²,

Abbas³

2011

TOCARIJ

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Abstract:The Takotsubo Cardiomyopathy (TC) also called broken heart syndrome, or stress-induced cardiomyopathy is characterized by the transient ballooning of the apex during systole as result of apical dyskinesia in conjunction with a compensatory hyperkinesia of the base of the left ventricle; in the absence of significant epicardial coronary artery disease. We report a case of TC with the characteristic findings of apical dyskinesia and perfusion abnormalities on gated SPECT which was diagnosed in retrospect after coronary angiography and left ventriculography. This is followed by a brief review of the scintigraphic techniques that have been used in the evaluation of TC. As TC accounts for at least 1-2% of presentations of acute coronary syndromes, increased awareness on the part of interpreting physicians is required for earlier diagnosis in the subset of patients referred for myocardial perfusion imaging.

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Section: Introductionsupporting

confidence: 58%

Scintigraphic Evaluation of Takotsubo Cardiomyopathy

Lalude¹,

Gutarra²,

Abbas³

2011

TOCARIJ

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“…Formerly, the catecholamine-induced myocardial toxicity was known under the entity "stunned myocardium" in cases of intracranial haemorrhages or paroxysms of pheochromocytoma [15][16][17][18]. Indeed, many studies demonstrated a dysfunction of the sympathetic system located at the apical level using I123-MIBG myocardial scintigraphy [14,19], an increase of plasma catecholamines levels Cardiovascular Medicine 2010;13(11):326-333 20] has been excluded by endomyocardial biopsies [16,[22][23][24], cardiac magnetic resonance imaging [23,28] and negative viral serologies [19,[22][23].…”

Section: Discussionmentioning

confidence: 99%

Stress-induced cardiomyopathy in a primary reference hospital: prevalence and clinical presentation

2010

Cardiovasc Med

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SummaryIntroduction: Stress-induced cardiomyopathy or Takotsubo cardiomyopathy is characterised by a transient localised systolic ventricular dysfunction without epicardial coronary artery disease and is typically provoked by emotional or physical stress. It mainly affects women presenting a greater vulnerability of their hyperactive sympathetic system.Aims: To determine the prevalence, clinical and paraclinical characteristics, complications, in-hospital mortality and recurrence rate of the disease in a primary Swiss reference centre. Results: A total of 31 patients presented with Takotsubo cardiomyopathy. 87% were female and the mean age was 72 ± 13 years. Symptoms included dyspnea or thoracic pain (74%). A trigger factor was present in 65% of the cases. The mean value of peak creatine kinase was 272 U/l and troponins 1.2 μ/L. The electrocardiograms mainly showed a ST-segment elevation in the precordial leads (74%) and a prolonged QTc-interval (77%). The mean left ventricular ejection fraction was 37 ± 10%. Right ventricular involvement was present in one third of the patients and was characterised by higher initial brain natriuretic peptide values. Three patients (10%) presented with midventricular ballooning. All patients completely recovered their cardiac function. Atrial tachyarrhythmias (16%), mainly fibrillation, and cardiogenic shock (13%) were the most frequent complications. The recurrence rate was 6%.Conclusion: The current study is the largest sample of Takotsubo cardiomyopathy patients in a Swiss primary reference centre. The results compare well with international published series. The prevalence was somewhat higher and dyspnea was more often the presenting symptom. This was likely due to the active search of the pathology, a high index of suspicion in front of a suggestive electrocardiogram and a low threshold for performing an echocardiogram in these patients.

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“…Acetylcholine provocation during catheterization has also not revealed inducible coronary spasms in this patient population. 2,22 The LV gram during the LHC demonstrates decreased or no motion of a portion of the LV myocardial wall (most commonly the apex) with the remaining myocardium becoming hypercontractile and apparently compensating (Figure 2, Patient 3). This asynergy results in a decreased LVEF.…”

Section: Cardiac Catheterization Lab and Morphologymentioning

confidence: 99%

“…2,3,22,33 In addition, the duration of wall motion abnormality in TCBS is usually longer than expected in conventional cases of coronary vasospasm. Endomyocardial biopsy has not revealed any evidence of myocarditis.…”

Section: Pathophysiology and Mechanismsmentioning

confidence: 99%

“…4 Single photon emission computed tomography (SPECT) iodine-123 metaiodobenzylguanidine (MIBG) myocardial scintigraphy found an increase in heartto-mediastinal ratio and global wash-out-rates of MIBG in patients with TCBS suggesting increased secretion and turnover of norepinephrine by sympathetic nerve terminals. 22 There is higher norepinephrine content and greater density of sympathetic nerves at the base of the heart 35,36 and the distal LV apical wall has been shown to be particularly vulnerable to myocardial stunning in catecholamine-mediated toxicity. This neurohormonal stunning is comprised of supraphysiologic levels of plasma catecholamines and other stress-related neuropeptides such as serotonin and neuropeptide Y.…”

Section: Pathophysiology and Mechanismsmentioning

confidence: 99%

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Transient Cardiac Ballooning—The Syndrome

Gupta

Sech

Lazzara

2009

Clinical Cardiology

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Transient cardiac ballooning is usually a reversible clinical entity. A patient typically presents with chest pain, electrocardiogram (ECG) abnormalities like ST‐segment elevation (most commonly reported) or depression, and elevated cardiac enzymes, but has no or nonobstructive coronary artery disease. Left ventriculography reveals transient akinesis of the involved portion of the myocardial wall with compensatory hyperkinesis of the remaining myocardium, leading to ballooning of the noncontracting myocardial wall during systole. Acute regional myocardial dysfunction ensues, which normalizes on average within 1 to 6 weeks. The hypotheses for these pathophysiologic changes range from direct cardiac myocyte injury to postischemic myocardial stunning to neurotransmitter actions. The objective of this article is to present a succinct description of a small case series accompanied with various recently reported presentations and morphology by left ventriculogram and a detailed review of available data on underlying pathophysiology. In addition, a discussion on current diagnostic guidelines, treatment, prognosis, and potential future investigations is included. Copyright © 2009 Wiley Periodicals, Inc.

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123I-MIBG myocardial scintigraphy in patients with reversible ventricular dysfunction Takotsubo cardiomyopathy

Cited by 121 publications

References 0 publications

Scintigraphic Evaluation of Takotsubo Cardiomyopathy

Scintigraphic Evaluation of Takotsubo Cardiomyopathy

Stress-induced cardiomyopathy in a primary reference hospital: prevalence and clinical presentation

Transient Cardiac Ballooning—The Syndrome

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