TY - JOUR
T1 - Basal hyperaemia is the primary abnormality of perfusion in Takotsubo cardiomyopathy
T2 - a quantitative cardiac perfusion positron emission tomography study
AU - Christensen, Thomas Emil
AU - Ahtarovski, Kiril Aleksov
AU - Bang, Lia Evi
AU - Holmvang, Lene
AU - Søholm, Helle
AU - Ghotbi, Adam Ali
AU - Andersson, Hedvig
AU - Vejlstrup, Niels
AU - Ihlemann, Nikolaj
AU - Engstrøm, Thomas
AU - Kjær, Andreas
AU - Hasbak, Philip
N1 - Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: [email protected].
PY - 2015/10
Y1 - 2015/10
N2 - Aims: Takotsubo cardiomyopathy (TTC) is characterized by acute completely reversible regional left ventricle (LV) akinesia and decreased tracer uptake in the akinetic region on semi-quantitative perfusion imaging. The latter may be due to normoperfusion of the akinetic mid/apical area and basal hyperperfusion. Our aim was to examine abnormalities of perfusion in TTC, and we hypothesized that basal hyperperfusion is the primary perfusion abnormality in the acute state. Method and results: Twenty-five patients were diagnosed with TTC due to (i) acute onset of symptoms, (ii) typical apical ballooning, (iii) absence of significant coronary disease, and (iv) complete remission on 4-month follow-up. The patients underwent coronary angiography (CAG), echocardiography, cardiac magnetic resonance imaging (CMR), and 13NH3/82Rb positron emission tomography (PET) in the acute state and-except CAG-on follow-up. Patients initially had severe heart failure, mid/apical oedema but no infarction, and a rise in cardiac biomarkers. On initial perfusion PET imaging, eight patients appeared to have normal, whereas 17 patients had impaired LV perfusion. In the latter, flow in the basal regionwas increased in the acute state (1.5±0.1 vs. 1.2±0.1 mL/g/minRPP-corrected, P < 0.01), whereas midventricular (1.7±0.1 vs. 1.6±0.1 mL/g/minRPP-corrected, P = 0.21) and apical (1.4±0.1 vs. 1.5±0.1 mL/g/minRPP-corrected, P = 0.36) flow was unchanged between acute and follow-up, and within normal range. Conclusion: Our results suggest an abnormal LV perfusion distribution in the acute state of TTC with basal hyperperfusion and a normoperfused akinetic region. The proportion of patients without visualized perfusion abnormalities in the acute state may represent a subgroup with fast remission.
AB - Aims: Takotsubo cardiomyopathy (TTC) is characterized by acute completely reversible regional left ventricle (LV) akinesia and decreased tracer uptake in the akinetic region on semi-quantitative perfusion imaging. The latter may be due to normoperfusion of the akinetic mid/apical area and basal hyperperfusion. Our aim was to examine abnormalities of perfusion in TTC, and we hypothesized that basal hyperperfusion is the primary perfusion abnormality in the acute state. Method and results: Twenty-five patients were diagnosed with TTC due to (i) acute onset of symptoms, (ii) typical apical ballooning, (iii) absence of significant coronary disease, and (iv) complete remission on 4-month follow-up. The patients underwent coronary angiography (CAG), echocardiography, cardiac magnetic resonance imaging (CMR), and 13NH3/82Rb positron emission tomography (PET) in the acute state and-except CAG-on follow-up. Patients initially had severe heart failure, mid/apical oedema but no infarction, and a rise in cardiac biomarkers. On initial perfusion PET imaging, eight patients appeared to have normal, whereas 17 patients had impaired LV perfusion. In the latter, flow in the basal regionwas increased in the acute state (1.5±0.1 vs. 1.2±0.1 mL/g/minRPP-corrected, P < 0.01), whereas midventricular (1.7±0.1 vs. 1.6±0.1 mL/g/minRPP-corrected, P = 0.21) and apical (1.4±0.1 vs. 1.5±0.1 mL/g/minRPP-corrected, P = 0.36) flow was unchanged between acute and follow-up, and within normal range. Conclusion: Our results suggest an abnormal LV perfusion distribution in the acute state of TTC with basal hyperperfusion and a normoperfused akinetic region. The proportion of patients without visualized perfusion abnormalities in the acute state may represent a subgroup with fast remission.
KW - Aged
KW - Biomarkers
KW - Coronary Angiography
KW - Echocardiography
KW - Electrocardiography
KW - Female
KW - Humans
KW - Hyperemia
KW - Magnetic Resonance Imaging
KW - Male
KW - Myocardial Perfusion Imaging
KW - Positron-Emission Tomography
KW - Radiopharmaceuticals
KW - Rubidium Radioisotopes
KW - Takotsubo Cardiomyopathy
KW - Ventricular Dysfunction, Left
U2 - 10.1093/ehjci/jev065
DO - 10.1093/ehjci/jev065
M3 - Journal article
C2 - 25851324
SN - 1525-2167
VL - 16
SP - 1162
EP - 1169
JO - European Heart Journal Cardiovascular Imaging
JF - European Heart Journal Cardiovascular Imaging
IS - 10
ER -