Myocardial scintigraphy in a patient with transient mid-ventricular ballooning cardiomyopathy: Case report

Yoshikawa, Masatomo; Yamamoto, Takeshi; Shirakabe, Akihiro; Ohno, Tadaaki; Tanaka, Keiji

doi:10.1016/j.ijcard.2007.01.076

Cited by 5 publications

(6 citation statements)

References 3 publications

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“…Similarly, the washout map showed an increased washout in the mid to basal portion of the inferior and lateral wall during the acute phase and increased the washout in the mid portion of the anterolateral wall in images taken 3 and 6 months later, suggesting how the abnormal findings of the 123I-mIBG persisted for 6 months even though the left ventricle contraction was recovered. The above-described findings concerning 123I-BMIPP scintigraphy are in line with a previous case report of a 51-year-old Japanese man published in 2007 by Yoshikawa and colleagues [78], who revealed a decreased uptake in the mid ventricle corresponding to the midventricular akinetic region, which normalized at 4 months after discharge. 99mTcsestamibi scintigraphy, also performed by the authors on the fifth day, showed no perfusion defects.…”

Section: Cardiac Nuclear Imaging Findings In Midventricular Ttcsupporting

confidence: 90%

“…Cardiac nuclear imaging findings in atypical variants of TTC reflect literature data published for the typical apical form, but with different distribution patterns of uptake defects. In particular, the analysis of the selected papers showed normal perfusion in most publications, with a mild reduction reported only in a minority of papers [70][71][72][73][74][75][76][77][78][79][80][81][82][83][84], always followed by complete normalization on follow-up studies when performed [75][76][77]. Perfusion G-SPECT confirmed the presence of motion and thickness abnormalities, associated with a reduction in LVEF during the acute phase, in accordance with echocardiographic findings [72].…”

Section: Discussion and Limitationssupporting

confidence: 59%

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Cardiac Nuclear Imaging Findings in Atypical Variants of Takotsubo Cardiomyopathy

De Feo,

Conte,

Frantellizzi

et al. 2024

Applied Sciences

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Background: In addition to the typical form resembling the classical Japanese octopus trap, atypical variants of Takotsubo cardiomyopathy (TTC) sparing the left ventricular apex have emerged over the years. The aim of this systematic review is to provide a comprehensive overview of the cardiac nuclear imaging findings in atypical variants. Methods: This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The literature research was carried out online on the Pubmed, Scopus, Central (Cochrane Library), and Web Of Science databases. Results: A total of 14 articles were ultimately selected. Myocardial perfusion scintigraphy was performed in nine studies, followed by 123I-mIBG scintigraphy, 123I-BMIPP scintigraphy, and 18F-FDG PET. In seven cases, a single cardiac nuclear imaging technique was performed, while in the remaining five and two cases, two and three different imaging modalities were, respectively, used. The most common atypical variant of our selection was the midventricular form, followed by reverse/inverted/basal TTC, with only a single case reported of a focal pattern. Conclusions: As the reason why TTC variants occur is still not clear, a deeper understanding of the current knowledge could be the basis for providing more insights into this fascinating disorder and its uncommon manifestations.

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Section: Cardiac Nuclear Imaging Findings In Midventricular Ttcsupporting

confidence: 90%

Section: Discussion and Limitationssupporting

confidence: 59%

Cardiac Nuclear Imaging Findings in Atypical Variants of Takotsubo Cardiomyopathy

De Feo,

Conte,

Frantellizzi

et al. 2024

Applied Sciences

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“…In a few reports, mid-ventricular ballooning diagnosed with 99m Tc-Tf perfusion study demonstrated myocardial perfusion abnormality was limited in narrow basal and mid-ventricular area and maintained almost normally in the apical area [5,7,8]. Similarly, previously diagnosed mid-ventricular ballooning in our hospital demonstrated moderately reduced perfusion in the small area of the mid-ventricle using 99m Tc-Tf study (Fig.…”

Section: Discussionsupporting

confidence: 57%

Atypical morphology and myocardial perfusion of mid-ventricular ballooning: A case report

Maeba

Kanazawa

Tsujimoto

et al. 2012

Journal of Cardiology Cases

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Although some atypical types of transient left ventricular apical ballooning syndrome have been reported, only a few atypical types of transient mid-ventricular ballooning have been reported. A 70-year-old female underwent surgery for urothelial carcinoma. At day 5 after the surgery, she was admitted to our department without cardiac symptoms because of ST elevation in leads I, II, III, aVF and V1-V6 indicating acute coronary syndrome. She was diagnosed with stress induced cardiomyopathy based on an angiographically normal coronary artery, newly developed extensive wall motion abnormality (hyperbasal contraction and akinesis from the mid-left ventricle to the apex without hypercontraction of the small area adjacent to the apex) based on left ventriculography, and a small elevation of myocardial enzymes incongruous with the area of contraction abnormality. Myocardial scintigraphy with 99m Tc-tetrofosmin showed a severely reduced myocardial perfusion in an extensive mid-ventricular area without a left ventricular base and top of apex, in accord with a wall motion abnormality different from typical apical ballooning or typical mid-ventricular ballooning previously diagnosed in our hospital. This is the first report presenting an atypical mid-ventricular ballooning based on the myocardial atypical perfusion findings.

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“…[5][6][7] TTC is often triggered by preceding physical or emotional stress, but its pathophysiologic bases remain poorly understood. 4,[8][9][10][11] We describe 2 didactic cases of TTC: the first with typical apical ballooning of the left ventricle and second with an uncommon LV midportion dilatation. In both patients LV perfusion, glucose metabolism, and sympathetic innervation were assessed by nuclear medicine techniques.…”

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confidence: 99%

Nuclear medicine imaging of takotsubo cardiomyopathy: Typical form and midventricular ballooning syndrome

Cimarelli

Impériale

Ben-Sellem

et al. 2008

Journal of Nuclear Cardiology

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Transient left ventricular (LV) apical ballooning syndrome, also known as takotsubo cardiomyopathy (TTC), was first described in the early 1990s in Japan. 1 TTC symptoms and electrocardiographic findings are close to those of acute myocardial infarction. 2 Cardiac enzyme levels, such as creatinine phosphokinase and troponin I, are slightly increased. During the acute phase, 2-dimensional transthoracic echocardiography (TTE) demonstrates akinesia or dyskinesia of the apical and midventricular segments associated with hypercontractility of the LV base. Emergency left ventriculography confirms TTE motion abnormalities and reveals a typical apical ballooning aspect at end systole. Coronary angiography reveals an absence of significant organic stenosis in the epicardial coronary arteries. 3,4 Variant forms of TTC, known as "inverted takotsubo" or "midventricular ballooning syndrome," have been described recently. 5-7 TTC is often triggered by preceding physical or emotional stress, but its pathophysiologic bases remain poorly understood. 4,[8][9][10][11] We describe 2 didactic cases of TTC: the first with typical apical ballooning of the left ventricle and second with an uncommon LV midportion dilatation. In both patients LV perfusion, glucose metabolism, and sympathetic innervation were assessed by nuclear medicine techniques.Patient 1: Transient ventricular apical ballooning. An 83-year-old white woman who had no cardiovascular history and was treated for mild hyperlipidemia was referred to our institution for further examination of ischemic-like chest pain. At admission, the systolic blood pressure was normal, and the heart rate was 85 beats/min with a regular rhythm. Respiratory crackles were heard bilaterally. Electrocardiography revealed STsegment elevation in the following leads: D1, aVL, and V 1 through V 6 . Biologic results showed a maximum troponin I level of 4.56 ng/mL (normal value Ͻ0.14 ng/mL) and total creatine kinase level of 390 IU/L (normal value Ͻ200 IU/L). TTE revealed LV apical akinesis, discrete dyskinesis of the septal mid-ventricle, and preserved basal function. The left ventricular ejection fraction (LVEF) was moderately decreased (40%). Coronary angiography showed normal epicardial coronary arteries. Left ventriculography confirmed wall motion abnormalities in the apical and mid-septal areas with hypercontractility of basal segments. TTE revealed improvement of LV wall motion and function (LVEF of 55%) within 1 month.Patient 2: Transient midventricular ballooning. A 67-year-old white woman with no prior history of cardiovascular disease and no coronary risk factors presented to our emergency department because of chest pain. Clinical examination and routine biologic evaluation showed no remarkable findings, except moderately increased troponin I and total creatine kinase levels: 4.15 ng/mL and 258 IU/L, respectively. Electrocardiographic recording was normal. At admission, TTE showed akinesis of LV mid-segments and hypercontractility of both apex and base. LVEF was moderately decreased (42%)....

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Myocardial scintigraphy in a patient with transient mid-ventricular ballooning cardiomyopathy: Case report

Cited by 5 publications

References 3 publications

Cardiac Nuclear Imaging Findings in Atypical Variants of Takotsubo Cardiomyopathy

Cardiac Nuclear Imaging Findings in Atypical Variants of Takotsubo Cardiomyopathy

Atypical morphology and myocardial perfusion of mid-ventricular ballooning: A case report

Nuclear medicine imaging of takotsubo cardiomyopathy: Typical form and midventricular ballooning syndrome

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