Key result
Nuclear imaging reveals inverse perfusion-metabolism mismatch in ~83% of patients with Takotsubo syndrome.
Why the study?
Takotsubo syndrome is increasingly recognized, and recent advances in nuclear imaging have enabled studying the condition in greater detail.
Nuclear imaging reveals that profound metabolic dysfunction out of proportion to perfusion defects is a hallmark of Takotsubo Syndrome.
Suggests metabolic dysfunction as a hallmark of Takotsubo syndrome; leaves open nuclear imaging's role in diagnosis or prognostication.
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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Nayar et al. (2022) conducted a review in Takotsubo Cardiomyopathy (TTS) (n=221). Nuclear imaging (PET and SPECT) was evaluated on Perfusion defect and inverse perfusion-metabolism mismatch. Nuclear imaging in patients with Takotsubo Syndrome revealed an inverse perfusion-metabolism mismatch in 82.8% and a perfusion defect in 31.2%, highlighting metabolic dysfunction.
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