Different pattern of regional metabolic abnormalities in Takotsubo cardiomyopathy as evidenced by F-18 FDG PET-CT

Rendl, Gundula; Rettenbacher, Lukas; Keinrath, P.; Altenberger, Johann; Schuler, Jochen; Heigert, Matthias; Pichler, Max; Pirich, Christian

doi:10.1007/s00508-010-1356-7

Cited by 13 publications

(8 citation statements)

References 5 publications

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“…It has previously been reported that catecholamine plays an adverse role in inducing apoptosis in cardiomyocytes [3], and many previous clinical studies have certified that none of inotropic agents improve prognosis when administered to patients with chronic heart failure [4]. Although one review article hypothesized that possible pathophysiological mechanisms include diffuse microvascular spasms with endothelial dysfunction, which is caused by excessive catecholamine release or oxidative stress [2], it has recently been reported that Takotsubo cardiomyopathy is accompanied by impaired glucose uptake in the heart [5][6][7]. This suggests that cardiomyocytes may be very sensitive to the pathological microenvironment as a consequence of glucose utilization.…”

mentioning

confidence: 97%

Systemic inflammation impairs cardiac glucose uptake

Kakinuma¹,

Okada²,

Nogami³

et al. 2012

International Journal of Cardiology

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mentioning

confidence: 97%

Systemic inflammation impairs cardiac glucose uptake

Kakinuma¹,

Okada²,

Nogami³

et al. 2012

International Journal of Cardiology

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“…High HDL-C is protective [9] and is associated with low VLDL and low triglycerides, as observed in our patients in TCM group. Metabolic abnormality has been suggested to play a role in TCM pathogenesis, whether these findings play a role in the inverse metabolic-perfusion mismatch observed in nuclear imaging studies needs further investigation [10-12]. …”

Section: Discussionmentioning

confidence: 99%

Serum lipoprotein levels in takotsubo cardiomyopathy vs. myocardial infarction

Gaddam¹,

Nimmagadda²,

Nagrani³

et al. 2011

Int Arch Med

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BackgroundIn the setting of myocardial infarction (MI) or acute coronary syndrome (ACS), current guidelines recommend early and aggressive lipid lowering therapy with statins, irrespective of the baseline lipoprotein levels. Takotsubo cardiomyopathy (TCM) patients have a clinical presentation similar to myocardial infarction and thus receive early and aggressive statin therapy during their initial hospitalization. However, the pathology of TCM is not atherosclerotic coronary artery disease and hence we assumed the lipid profiles in TCM would be healthier than coronary artery disease patients.MethodsIn this retrospective study, we assessed fasting serum lipoprotein levels of ten TCM patients and compared them with forty, age and sex-matched myocardial infarction (MI) patients.ResultsComparing serum lipoprotein levels of TCM with MI group, there was no significant difference in mean total cholesterol between the two groups (174.5 mg/dL vs. 197.6 mg/dL, p = 0.12). However, in the TCM group, mean HDL-C was significantly higher (66.87 mg/dL vs. 36.5 mg/dL, p = 0.008), the mean LDL-C was significantly lower (89.7 mg/dL vs. 128.9 mg/dL, p = 0.0002), and mean triglycerides was also significantly lower (65.2 mg/dL vs. 166.8 mg/dL, p < 0.0001).ConclusionsIn this study, TCM patients in comparison to MI patients had significantly higher levels of HDL-C, lower levels of LDL-C levels and triglycerides. The lipid profiles in TCM were consistent with the underlying pathology of non-atherosclerotic, non-obstructive coronary artery disease. As lipoproteins in most TCM patients were within the optimal range, we recommend an individual assessment of lipid profiles along with their coronary heart disease risk factors for considering long term lipid-lowering therapy. A finding of hyperalphalipoproteinemia or hypotriglyceridemia in 40% of TCM patients is novel but this association needs to be confirmed in future studies with larger sample sizes. These findings may provide clues in understanding the pathogenesis of takotsubo cardiomyopathy.

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“…Positron emission tomography and Takotsubo cardiomyopathy they observed that the extension of the metabolic defect was much larger and more severe than the perfusion defect with 201 Tl. In the other three studies [11][12][13] , most of patients (20/24, 83.3%) showed a severe reduction of metabolic activity in the apex and periapical segments in the acute phase of TTC. This reduction of FDG uptake in the dysfunctional areas recovered at follow-up, following the normalization of left ventricle function.…”

Section: The Myocardial Glucose Metabolismmentioning

confidence: 95%

“…Four articles [10][11][12][13] were included in our clinical review (see Table 1); one is from Japan, one from Italy, one from France and the last from Austria. The main characteristics of the studies included in this review are reported in Table 1.…”

Section: Studies' Characteristicsmentioning

confidence: 99%

“…Nuclear medicine techniques have been successfully employed in the differential diagnosis of TTC from ACS and have demonstrated a discrepancy between normal perfusion and reduced 18 F-FDG uptake in TTC [8,9] . This association is commonly known as "inverse metabolicperfusion mismatch" and represented a transient metabolic disorder at the cellular level, demonstrated by evidence of tissue's impairment metabolism in the dysfunctioning left ventricle with preserved MBF at rest [10][11][12][13] . Moreover, PET imaging, using the quantitative analysis, confirmed the light impairment of MBF in dysfunctioning LV segments in the acute phase together with a clearly reduction of CFR after vasodilator stimuli.…”

Section: Peer Reviewmentioning

confidence: 99%

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Usefulness of myocardial positron emission tomography/nuclear imaging in Takotsubo cardiomyopathy

Testa¹,

Feola²

2014

WJR

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AIM:To analyse and summarize all the articles related to positron emission tomography and Takotsubo cardiomyopathy (TTC). METHODS:We performed a systematic review of the existing literature on positron emission tomography/ nuclear imaging and Takotsubo cardiomyopathy using PUBMED database. We combined search terms such as "takotsubo", "takotsubo syndrome", "myocardial positron emission tomography", "positron emission tomography". All case reports were excluded. The list included only four articles which were reviewed by two independent investigators. It was not possible to undertake a formal meta-analysis because of the heterogeneity of the studies; therefore, we made a narrative synthesis of the collected data. RESULTS:Nuclear medicine techniques can be useful employed in the differential diagnosis of TTC from an acute coronary syndrome (ACS). In fact, transient left ventricular (LV) apical ballooning is a syndrome frequently misdiagnosed as an ACS and can mimic symptoms of myocardial infarction with ST-T segments changes on electrocardiography (ECG), a limited release of myocardial enzyme, mainly reported after sudden emotional or physical stress, and an akinesis or dyskinesis of the left ventricle apex which are completely reversible in a few weeks. In the studies included in this review, nuclear medicine techniques have demonstrated a discrepancy between normal perfusion and a reduced glucose utilization in TTC, commonly known as "inverse flow metabolism mismatch". This suggests that apical ballooning represents a transient metabolic disorder on the cellular level, rather than a structural contractile disease of the myocardium, due to a transient decrease of glucose metabolism that might be related to a coronary microcirculation impairment followed by prolonged myocardial stunning. CONCLUSION:Nuclear medicine techniques can be usefully used for the diagnosis of TTC and can increase our knowledge of the pathophysiological mechanisms of TTC. Core tip: Takotsubo cardiomyopathy is a cardiac syndrome with symptoms similar to acute myocardial infarction (MI) including chest pain and electrocardiographic changes, in absence of coronary artery stenosis. This syndrome is characterized by reversible wall-motion abnormalities involving apical and midportion of left ventricle. In the acute phase it is clinically indistinguishable from acute MI but, recently, myocardial positron emission tomography have demonstrated to delineate this syndrome from acute coronary artery disease, also offering a new pathophysiological explanation for this particular syndrome. This clinical review aimed to summarise the most significant experiences on the use of myocardial positron emission tomography in Takotsubo cardiomyopathy. SYSTEMATIC REVIEWS

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Different pattern of regional metabolic abnormalities in Takotsubo cardiomyopathy as evidenced by F-18 FDG PET-CT

Abstract: Diff erent pattern of regional metabolic abnormalities © Springer-Verlag 5-6/2010 wkw 184 letter to the editor Confl ict of interestTh e authors declare no confl ict of interest.

Cited by 13 publications

References 5 publications

Systemic inflammation impairs cardiac glucose uptake

Systemic inflammation impairs cardiac glucose uptake

Serum lipoprotein levels in takotsubo cardiomyopathy vs. myocardial infarction

Usefulness of myocardial positron emission tomography/nuclear imaging in Takotsubo cardiomyopathy

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