Key result
F-18 FDG PET imaging in patients with tako-tsubo cardiomyopathy demonstrated that the extent of metabolic defect in the apical akinetic area was more severe than the perfusion abnormality.
Observational (n=15)
In tako-tsubo cardiomyopathy, metabolic defects in the apical akinetic area are more severe than perfusion abnormalities, suggesting a catecholamine-induced metabolic disorder.
Stress-induced metabolic defects in Takotsubo warrant mechanistic studies; clinical implications remain uncertain pending larger trials.
UNLABELLED: AIMS; Our study aims to investigate the pathophysiologic mechanism underlying tako-tsubo cardiomyopathy using F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET). METHODS AND RESULTS: Fifteen patients with tako-tsubo cardiomyopathy were enrolled in this study. Plasma catecholamines, cardiac troponin T (cTnT), and D-dimer were serially evaluated in all patients. Thallium-201 ((201)Tl) single-photon emission computed tomography (SPECT) and F-18 FDG PET were performed in 10 and eight patients, respectively. Emotional or physical stress occurred in 12 (80.0%) patients. ST-T segment abnormalities existed in all patients. Thirteen patients exhibited mildly elevated cTnT, although coronary angiography did not reveal significant stenosis in any patient. Endomyocardial biopsy specimens (n = 9) demonstrated contraction-band necrosis (n = 4) and mononuclear cell infiltration (n = 3). The levels of norepinephrine and epinephrine peaked on admission (744 +/- 452 and 140 +/- 166 pg/mL, respectively). There was severely reduced uptake at the apex on F-18 FDG PET image, despite slightly reduced uptake of (201)Tl. Elevation of D-dimer was observed in nine patients. CONCLUSION: The extent of metabolic defect involving apical akinetic area was more severe than perfusion abnormality. Our data suggest that sudden emotional or physical stress may cause a catecholamine-induced metabolic disorder in the myocardium, which is probably central to this syndrome.
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Yoshida et al. (2007) conducted an observational in Tako-tsubo cardiomyopathy (n=15). F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) was evaluated on Metabolic and perfusion abnormalities. F-18 FDG PET imaging in patients with tako-tsubo cardiomyopathy demonstrated that the extent of metabolic defect in the apical akinetic area was more severe than the perfusion abnormality.
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