Spectrum of radionuclide perfusion study abnormalities in takotsubo cardiomyopathy

Anderson, Jeffrey L.; Horne, Benjamin D.; Le, Viet T; Bair, Tami L; Min, David; Minder, C. Michael; Dhar, Ritesh; Mason, Steve; Muhlestein, Joseph B.; Knowlton, Kirk U.

doi:10.1007/s12350-020-02385-w

Cited by 10 publications

(5 citation statements)

References 39 publications

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“…The role of perfusion abnormalities in TTS is a matter of debate as both increased and decreased perfusion have been described by radionucleotide perfusion studies (RPS). Anderson et al analyzed the Intermountain Healthcare electronic medical records which contained 16 patients with TTS who had RPS [ 2 ]. The tracers used were 82 Rb PET/CT in eight, 99m Tc sestamibi SPECT in six, and 201 Tl SPECT in two.…”

Section: Discussionmentioning

confidence: 99%

A Review of Nuclear Imaging in Takotsubo Cardiomyopathy

Nayar

John

Philip³

et al. 2022

Life

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Takotsubo cardiomyopathy or Takotsubo Syndrome (TTS) is a reversible left ventricular dysfunction syndrome that is increasingly being recognized. Recent advances in nuclear imaging have allowed us to study TTS in greater detail. We searched the PubMed and Medline databases and identified 53 publications with 221 patients reporting nuclear imaging findings in TTS. The age of the patients ranged from 17 to 87 years and were predominantly women (88.2%). The TTS variant was apical (typical) in 170 (76.9%), mid-ventricular in 23 (10.4%), and basal (reverse TTS) in 2 (0.9%). Cardiac perfusion was assessed using 99mTc sestamibi (MIBI) SPECT, 99mTc tetrofosmin SPECT, 201Tl SPECT, 82Rb PET, 201Tl SPECT, and 13N ammonia PET. Additional studies used were 123I MIBG SPECT, 123I BMIPP SPECT, 18F FDG PET, 67Ga citrate, and 11C hydroxy-ephedrine. A perfusion defect was seen in 69 (31.2%), and an inverse perfusion–metabolism mismatch (normal or near-normal perfusion with absent myocardial metabolic activity) was seen in 183 (82.8%) patients. Nuclear imaging has a significant role in evaluating, diagnosing, and prognosticating patients with TTS. As nuclear imaging technology evolves, we will surely gain more insights into this fascinating disorder.

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Section: Discussionmentioning

confidence: 99%

A Review of Nuclear Imaging in Takotsubo Cardiomyopathy

Nayar

John

Philip³

et al. 2022

Life

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“…Nuclear medicine techniques represent the non-invasive gold-standard for evaluation of non-endothelial dependent microvascular function in absence of obstructive coronary artery disease (CAD) by measuring absolute MBF and MBF reserve [ 68 ]. Small studies have demonstrated minor perfusion abnormalities in patients with TTS by 18-fluorodeoxyglucose (FDG) positron emission tomography (PET) or single-photon emission computed tomography (SPECT) imaging [ 69 ]. Nuclear medicine imaging has proven its worth also in giving insight about the physiopathology of TTS, showing an “inverse metabolic perfusion mismatch” characterized by an impaired metabolism in the involved LV regions with normal MBF at rest [ 70 , 71 , 72 ].…”

Section: Coronary Microvascular Dysfunctionmentioning

confidence: 99%

Impact of Coronary Microvascular Dysfunction in Takotsubo Syndrome: Cause, Consequence or Both?

Caglioni,

Mele,

Milzi

et al. 2024

Rev. Cardiovasc. Med.

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Takotsubo syndrome (TTS) is an acute cause of heart failure characterized by a reversible left ventricular (LV) impairment usually induced by a physical or emotional trigger. TTS is not always a benign disease since it is associated with a relatively higher risk of life-threatening complications, such as cardiogenic shock, ventricular arrhythmias, respiratory failure, cardiopulmonary resuscitation and death. Despite notable advancements in the management of patients with TTS, physiopathological mechanisms underlying transient LV dysfunction remain largely unknown. Since TTS carries similar prognostic implications than acute myocardial infarction, the identification of mechanisms and predictors of worse prognosis remain key to establish appropriate treatments. The greater prevalence of TTS among post-menopausal women and the activation of the neuro-cardiac axis triggered by physical or emotional stressors paved the way forward to several studies focused on coronary microcirculation and impaired blood flow as the main physiopathological mechanisms of TTS. However, whether microvascular dysfunction is the cause or a consequence of transient LV impairment remains still unsettled. This review provides an up-to-date summary of available evidence supporting the role of microvascular dysfunction in TTS pathogenesis, summarizing contemporary invasive and non-invasive diagnostic techniques for its assessment. We will also discuss novel techniques focused on microvascular dysfunction in TTS which may support clinicians for the implementation of tailored treatments.

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“…Stressors vary widely among reports of TTC cases and include natural disasters to weddings and surprise parties, from surgery and anesthesia to thyrotoxicosis [19] and sepsis, from the postpartum period [20,21] to COVID-19 infection [22], from subarachnoid hemorrhage and stroke to pancreatitis and cholecystitis, from pheochromocytoma to neoplasm and cancer-related therapies, and so on [23]. The reaction to stressors depends on individual factors influencing both catecholamine production and myocyte and microvascular response to sympathetic stimulation [24], with estrogen deficiency, genetic factors, and neurologic and psychiatric disorders being predisposing factors to mental and physical triggers [25][26][27][28][29]. Despite the clinical presentation usually mimicking ACS [30], with patients often presenting with chest pain, followed by dyspnea and syncope [31], having electrocardiographic abnormalities (ST-segment elevation, ST-segment depression, T-wave negative conversion, and QT prolongation) [32] and showing a mild elevation of myocardionecrosis enzyme levels, as well as the marked elevation of brain natriuretic peptide (BNP) and N-terminal pro-BNP [33][34][35][36], TTC is formally considered a benign self-limiting state presenting a favorable prognosis [37] and it is generally characterized by a temporary impairment with complete recovery within 3 weeks.…”

Section: Introductionmentioning

confidence: 99%

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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Spectrum of radionuclide perfusion study abnormalities in takotsubo cardiomyopathy

Cited by 10 publications

References 39 publications

A Review of Nuclear Imaging in Takotsubo Cardiomyopathy

A Review of Nuclear Imaging in Takotsubo Cardiomyopathy

Impact of Coronary Microvascular Dysfunction in Takotsubo Syndrome: Cause, Consequence or Both?

Cardiac Nuclear Imaging Findings in Atypical Variants of Takotsubo Cardiomyopathy

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