Key result
SPECT/CT and PET/CT fusion imaging in a patient with Takotsubo cardiomyopathy revealed increased glucose metabolism likely due to inflammation and reduced fatty acid metabolism.
Case Report (n=1)
Multimodality fusion imaging in Takotsubo cardiomyopathy demonstrates a mismatch between severely impaired fatty acid metabolism and increased glucose metabolism in the acute phase, suggesting myocardial inflammation.
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Fusion imaging shows metabolic mismatch in one Takotsubo case; hypothesis-generating and should not yet change practice.
An 85-year-old female was referred with chest pain. The electrocardiogram showed ST-elevation in the precordial leads. A routine biological evaluation showed increased troponin T (1.32 ng/mL), total creatine kinase (CK) (687 IU/L), and CKMB (60.0 IU/L). Emergent coronary arteriography showed no stenosis and revealed acetylcholine-inducible spasm of the right coronary artery (RCA). Left ventriculography and transthoracic echocardiography demonstrated remarkable apical ballooning and hyperdynamic contraction of the basal segment (Panel A). Therefore, we diagnosed the patient with Takotsubo cardiomyopathy. 99mTc-sestamibi (MIBI) and 123I-beta-methyl iodophenyl pentadecanoic acid SPECT and 18F-fluorodeoxyglucose (18F-FDG) PET were performed on Days 5 and 6. 123I-beta-methyl iodophenyl pentadecanoic acid images revealed a severely reduced uptake in the apex and a slightly reduced uptake of MIBI in the same region (Panels B and C). These results demonstrated severely impaired fatty acid metabolism rather than myocardial perfusion during the acute phase. The 18F-fluorodeoxyglucose PET image showed an obvious focal FDG accumulation in the apex. (Panel D). In this case, 18F-FDG injection was performed after prolonged fasting, unlike the procedure followed in the standardized glucose loading state. The normal myocardium primarily utilizes free fatty acids in the fasting state, and physiological accumulation of 18F-FDG in the normal myocardium was inhibited. Therefore, high uptake of 18F-FDG in the fasting state suggests an impaired myocardium, including the presence of inflammation. In summary, SPECT/CT and PET/CT fusion imaging revealed increased glucose metabolism probably due to inflammation and a reduction of fatty acid metabolism that was inconsistent with a spastic lesion of the RCA. Transthoracic echocardiography demonstrated complete resolution of left ventricular wall motion within 1 week. Supplementary material is available at European Heart Journal online.
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Miyachi et al. (2012) conducted a case report in Takotsubo cardiomyopathy (n=1). PET/CT and SPECT/CT cardiac fusion imaging was evaluated on Cardiac imaging findings (metabolism and perfusion). SPECT/CT and PET/CT fusion imaging in a patient with Takotsubo cardiomyopathy revealed increased glucose metabolism likely due to inflammation and reduced fatty acid metabolism.
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