Stelvio Sestini1, Francesco Pestelli2, Mario Leoncini2, Francesco Bellandi2, Christian Mazzeo3, Luigi Mansi4, Ignasi Carrio5, Antonio Castagnoli3. 1. Deptartment of Diagnostic Imaging, Nuclear Medicine Unit, N.O.P. - S. Stefano, U.S.L. Toscana Centro, via Suor Niccolina Infermiera 20, 59100, Prato, Italy. stelvio.sestini@uslcentro.toscana.it. 2. Deptartment of Internal Medicine, Cardiovascular Unit, N.O.P. - S. Stefano, U.S.L, Toscana Centro, Prato, Italy. 3. Deptartment of Diagnostic Imaging, Nuclear Medicine Unit, N.O.P. - S. Stefano, U.S.L. Toscana Centro, via Suor Niccolina Infermiera 20, 59100, Prato, Italy. 4. Deptartment of Diagnostic Imaging, Nuclear Medicine Unit, University II Naples, Naples, Italy. 5. Nuclear Medicine, Hospital Sant Pau, Barcelona, Spain.
Abstract
PURPOSE: To investigate changes in sympathetic activity, perfusion, and left ventricular (LV) functionality in takotsubo cardiomyopathy (TTC) patients from onset (T0) to post-onset conditions at 1 month (T1), 1-2 years (T2, T3). METHODS: Twenty-two patients (70 ± 11 years) underwent serial gated single photon emission tomography (G-SPECT) studies with 123I-mIBG and 99mTc-Sestamibi. Statistics were performed using ANOVA/Sheffé post-hoc, correlation test, and receiver operating characteristic (ROC) curve analysis (p < 0.05). RESULTS: Patients presented at T0 with LV ballooning and reduced early-late mIBG uptake (95%, 100%), left ventricular ejection fraction (LVEF)G-SPECT (86%) and perfusion (77 %). Adrenergic dysfunction was greater in apex, it overlaps with contractile impairment, and both were more severe than perfusion defect. During follow-up, LVEFG-SPECT, contractility, and perfusion were normal, while 82% and 90% of patients at T1 and 50% at T2 and T3 continued to show a reduced apical early-late mIBG distribution. These patients presented at T0-T1 with greater impairment of adrenergic function, contractility, and perfusion. A relationship was present within innervation and both perfusion and contractile parameters at T0 and T1, and between the extent of adrenergic defect at T3 and both the defect extent and age at T0 (cut-off point 42.5%, 72 years). CONCLUSION: Outcome for TTC is not limited to a reversible contractile and perfusion abnormalities, but it includes residual adrenergic dysfunction, depending on the level of adrenergic impairment and age of patients at onset. The number of patients, as well as degree of perfusion abnormalities were found to be higher than those previously reported possibly depending on the time-interval between hospital admission and perfusion scan.
PURPOSE: To investigate changes in sympathetic activity, perfusion, and left ventricular (LV) functionality in takotsubo cardiomyopathy (TTC) patients from onset (T0) to post-onset conditions at 1 month (T1), 1-2 years (T2, T3). METHODS: Twenty-two patients (70 ± 11 years) underwent serial gated single photon emission tomography (G-SPECT) studies with 123I-mIBG and 99mTc-Sestamibi. Statistics were performed using ANOVA/Sheffé post-hoc, correlation test, and receiver operating characteristic (ROC) curve analysis (p < 0.05). RESULTS:Patients presented at T0 with LV ballooning and reduced early-late mIBG uptake (95%, 100%), left ventricular ejection fraction (LVEF)G-SPECT (86%) and perfusion (77 %). Adrenergic dysfunction was greater in apex, it overlaps with contractile impairment, and both were more severe than perfusion defect. During follow-up, LVEFG-SPECT, contractility, and perfusion were normal, while 82% and 90% of patients at T1 and 50% at T2 and T3 continued to show a reduced apical early-late mIBG distribution. These patients presented at T0-T1 with greater impairment of adrenergic function, contractility, and perfusion. A relationship was present within innervation and both perfusion and contractile parameters at T0 and T1, and between the extent of adrenergic defect at T3 and both the defect extent and age at T0 (cut-off point 42.5%, 72 years). CONCLUSION: Outcome for TTC is not limited to a reversible contractile and perfusion abnormalities, but it includes residual adrenergic dysfunction, depending on the level of adrenergic impairment and age of patients at onset. The number of patients, as well as degree of perfusion abnormalities were found to be higher than those previously reported possibly depending on the time-interval between hospital admission and perfusion scan.
Authors: Scott W Sharkey; Denise C Windenburg; John R Lesser; Martin S Maron; Robert G Hauser; Jennifer N Lesser; Tammy S Haas; James S Hodges; Barry J Maron Journal: J Am Coll Cardiol Date: 2010-01-26 Impact factor: 24.094
Authors: Tetsuo Sasano; M Roselle Abraham; Kuan-Cheng Chang; Hiroshi Ashikaga; Kevin J Mills; Daniel P Holt; John Hilton; Stephan G Nekolla; Jun Dong; Albert C Lardo; Henry Halperin; Robert F Dannals; Eduardo Marbán; Frank M Bengel Journal: J Am Coll Cardiol Date: 2008-06-10 Impact factor: 24.094
Authors: Alejandro Lemor; Alvaro J Ramos-Rodriguez; Ricardo De La Villa; Seyed H Hosseini Dehkordi; Fernando Vazquez de Lara; Shawn Lee; Mario Rodriguez Rivera; Abel Casso Dominguez; Edgar Argulian Journal: Clin Cardiol Date: 2018-11-26 Impact factor: 2.882