Serial changes of myocardial perfusion imaging in takotsubo and reverse takotsubo cardiomyopathy

Figures

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  Figure 1. Electrocardiogram (ECG) on presentation to emergency department (A) and left ventriculography (LVG) during diastole (B) and systole (C) in a takotsubo cardiomyopathy (TTC) patient. ECG in a TTC patient showed negative T wave in leads I, II, aVL, V2-V6, and –aVR. LVG in a TTC patient demonstrated severe hypokinesis in the apical segment (C, dotted line) and hyperkinesis in the basal segment (C, arrow head)

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  Figure 2. Electrocardiogram (ECG) on presentation to emergency department (A) and left ventriculography (LVG) during diastole (B) and systole (C) in a reverse takotsubo cardiomyopathy (rTTC) patient. ECG in a TTC patient showed negative T wave in leads I, II, aVL, and V1-V6. LVG in a rTTC patient demonstrated severe hypokinesis in the basal segment (C, dotted line) and hyperkinesis in the apical segment (C, arrow head)

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  Figure 3. Flow chart depicting inclusion of the study population. We performed myocardial perfusion scintigraphy using Tc-99m sestamibi for 2076 patients between April 2004 and March 2013 in our hospital. 392 patients were diagnosed with a cardiomyopathy, and 30% of them (119 patients) had takotsubo cardiomyopathy or its variant (TTC: 86 patients, rTTC: 10 patients, midventricular: 23 patients). Moreover, 28 patients with takotsubo cardiomyopathy or its variant underwent myocardial perfusion scintigraphy using Tc-99m sestamibi in the acute and chronic phase (TTC: 20 patients, rTTC: 8 patients). TTC, takotsubo cardiomyopathy; rTTC, reversed takotsubo cardiomyopathy

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  Figure 4. The definition of the minimum-%-uptake (min-%-uptake) in the acute phase and chronic phase. Min-%-uptake was defined the %-uptake in the segment where the accumulation was the lowest in the acute phase on the Bull’s eye map and the same segment in the chronic phase. TTC, takotsubo cardiomyopathy; rTTC, reversed takotsubo cardiomyopathy; VLA, vertical long-axis; SA, short-axis; HLA, horizontal long-axis; Ant, anterior; SEP, septal; LAT, lateral; INF, inferior

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  Figure 5. The definition of the extent score (ES). ES was calculated using the Bull’s eye map, with the corresponding lower normal limits at 2.5 standard deviations below the average values derived from the normal data. TTC, Takotsubo cardiomyopathy; rTTC, reversed takotsubo cardiomyopathy; Ant, anterior; SEP, septal; LAT, lateral; INF, inferior; APX, apex; TOT, total

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  Figure 6. Serial changes of the minimum-%-uptake (min-%-uptake). The min-%-uptake was improved from the acute to the chronic phase in TTC and rTTC group. TTC, takotsubo cardiomyopathy; rTTC, reverse takotsubo cardiomyopathy

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  Figure 7. Serial changes of Extent score. Extent score was also improved from acute to chronic phase in TTC and rTTC group. TTC, takotsubo cardiomyopathy; rTTC, reverse takotsubo cardiomyopathy

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  Figure 8. Serial changes of Summed rest score. Summed rest score was also improved from acute to chronic phase in TTC and rTTC group. TTC, takotsubo cardiomyopathy; rTTC, reverse takotsubo cardiomyopathy