Takotsubo-cardiomyopathy: A case of extremely fast recovery described by multimodality cardiac imaging
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From the Department of Clinical Physiology, Nuclear Medicine & PET,a Department of Cardiology,b Rigshospitalet, Copenhagen, Denmark. Reprint requests: Thomas Emil Christensen, Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Copenhagen, Denmark; [email protected]. J Nucl Cardiol 2012;19:1240–2. 1071-3581/$34.00 Copyright Ó 2012 American Society of Nuclear Cardiology. doi:10.1007/s12350-012-9620-z 1240
(Figure 2A-C). The patient was diagnosed with Takotsubo cardiomyopathy.
DISCUSSION Takotsubo is an intriguing human model disease to study reversible acute cardiac stunning. In stunning, the functional abnormalities are reversible.1 Extremely fast recovery of Takotsubo has been described previously. The temporary apical hypocontractility after disappearance of the apical ballooning and normalisation of the LVEF is an expected observation, but is previously undescribed. The relationship between ventricular contractility and coronary blood flow is well established.2 In this case, contractility and flow is also closely related: The hypocontractility, in the apical and slightly increased contractility in the basal region (as seen on the second MRI), is apparently enough to generate a perfusion pattern as we have previously described in a takotsubo patient in the presence of apical ballooning: Preserved flow in the apical and hyperaemia in the basal, hypercontractile region of the ventricle.3 However, the observed apical perfusion defect may also partly be due to the partial volume effect, where lack of apical systolic thickening produces an apparent perfusion defect compared to basal regions that demonstrate systolic thickening.
Journal of Nuclear Cardiology Volume 19, Number 6;1240–2
Christensen et al Takotsubo-cardiomyopathy
Figure 1. Apical ballooning as seen on ventriculography (A). Cardiac SPECT during resting conditions 15 hours after admittance shows a relative perfusion reduction in the apex (B). Initial MRI of the heart 22 hours after admittance shows apical ballooning and LVEF 40% (C). Echocardiography with Wall Motion Index 35 hours after admittance shows akinesia of the most apical parts of the left ventricle and a near-normal LVEF 50% (D). Follow-up MRI 48 hours after admittance shows apical edema but normal LVEF 70% (E). NH3-PET scan 59 h after admittance shows that the perfusion abnormality seen on the cardiac SPECT is persistent and is actually due to hyperperfusion of the basal segments of the left ventricle, color table on the side coded for absolute blood flow (0.0-2.0 mL/minute/g) (F).
Figure 2. A normalized echocardiography (A), MRI (B), and NH3-PET, color table on the side coded for absolute blood flow (0.0-2.0 mL/minute/g) (C).
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Christensen et al Takotsubo-cardiomyopathy
Conflict of interest The authors have indicated that they have no financial conflicts of interest.
References 1. Bolli R. Mechanism of myocardial ‘‘stunning’’. Circulation 1990; 82:723-38.
Journal of Nuclear Cardiology November/December 2012
2. Gregg DE. Blood sup
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