(123)I-MIBG Scintigraphy in the Subacute State of Takotsubo Cardiomyopathy

Thomas Emil Christensen; Lia Evi Bang; Lene Holmvang; Dorthe Charlotte Skovgaard; Ditte Bang Oturai; Helle Søholm; Jakob Hartvig Thomsen; Hedvig Bille Andersson; Adam Ali Ghotbi; Nikolaj Ihlemann; Andreas Kjaer; Philip Hasbak

doi:10.1016/j.jcmg.2016.01.028

(123)I-MIBG Scintigraphy in the Subacute State of Takotsubo Cardiomyopathy

Thomas Emil Christensen, Lia Evi Bang, Lene Holmvang, Dorthe Charlotte Skovgaard, Ditte Bang Oturai, Helle Søholm, Jakob Hartvig Thomsen, Hedvig Bille Andersson, Adam Ali Ghotbi, Nikolaj Ihlemann, Andreas Kjaer, Philip Hasbak

34 Citations (Scopus)

Abstract

OBJECTIVES: The study sought to investigate adrenergic activity in patients with takotsubo cardiomyopathy (TTC).

BACKGROUND: TTC is a specific type of reversible heart failure possibly caused by excessive catecholamine stimulation of the myocardium. Scintigraphic iodine-123-meta-iodobenzylguanidine (mIBG) imaging of the heart and measurement of plasma catecholamines can be used to assess adrenergic activity in vivo. The authors hypothesized that sympathetic nerve activity is increased in the subacute state of TTC, and this study used cardiac mIBG imaging and plasma levels of norepinephrine and epinephrine as markers to assess this hypothesis.

METHODS: In this study, 32 patients with TTC and 20 controls were examined at admission and again on follow-up with echocardiography, mIBG scintigraphy, and plasma catecholamine measurements.

RESULTS: Ejection fraction (EF) was initially 36 ± 9% but increased to >60% (p = 0.0004) in all patients with TTC. In the control subjects EF was initially higher (51 ± 11%; p = 0.0004) than in the patients with TTC. However, EF of the patients with TTC exceeded that of the control subjects on follow-up (56 ± 8%; p = 0.0007). The mIBG imaging showed a lower late (4-h) heart-to-mediastinum ratio (H/Mlate) (2.00 ± 0.38) and a higher washout rate (WR) (45 ± 12%) in the subacute state of TTC, both when compared with follow-up (H/Mlate: 2.42 ± 0.45; p = 0.0004; WR: 33 ± 14%; p = 0.0004) and when compared with the control group in the subacute state (H/Mlate: 2.34 ± 0.60, p = 0.035; WR: 33 ± 19%, p = 0.026). On follow-up, no differences in mIBG parameters were observed between the TTC and control groups (H/Mlate: 2.41 ± 0.51, p = 0.93; WR: 30 ± 13%, p = 0.48) group. In the TTC group, plasma epinephrine levels were elevated in the subacute state (Log2[epinephrine]: 6.13 ± 1.04 pg/ml), both when compared with follow-up (5.25 ± 0.62 pg/ml; p = 0.0004) and when compared with the control group in the subacute state (5.46 ± 0.69 pg/ml; p = 0.044), and these levels remained elevated in the TTC group on follow-up compared with the control group (4.56 ± 0.95 pg/ml; p = 0.014). No significant differences in plasma norepinephrine levels were observed.

CONCLUSIONS: The present study supports a possible role of adrenergic hyperactivity in TTC.

Original language	English
Journal	JACC. Cardiovascular imaging
Volume	9
Issue number	8
Pages (from-to)	982-90
Number of pages	9
ISSN	1876-7591
DOIs	https://doi.org/10.1016/j.jcmg.2016.01.028
Publication status	Published - 1 Aug 2016

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Journal Article

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10.1016/j.jcmg.2016.01.028

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@article{d4ca52614c7b45788568fc2eae624e3e,

title = "(123)I-MIBG Scintigraphy in the Subacute State of Takotsubo Cardiomyopathy",

abstract = "OBJECTIVES: The study sought to investigate adrenergic activity in patients with takotsubo cardiomyopathy (TTC).BACKGROUND: TTC is a specific type of reversible heart failure possibly caused by excessive catecholamine stimulation of the myocardium. Scintigraphic iodine-123-meta-iodobenzylguanidine (mIBG) imaging of the heart and measurement of plasma catecholamines can be used to assess adrenergic activity in vivo. The authors hypothesized that sympathetic nerve activity is increased in the subacute state of TTC, and this study used cardiac mIBG imaging and plasma levels of norepinephrine and epinephrine as markers to assess this hypothesis.METHODS: In this study, 32 patients with TTC and 20 controls were examined at admission and again on follow-up with echocardiography, mIBG scintigraphy, and plasma catecholamine measurements.RESULTS: Ejection fraction (EF) was initially 36 ± 9% but increased to >60% (p = 0.0004) in all patients with TTC. In the control subjects EF was initially higher (51 ± 11%; p = 0.0004) than in the patients with TTC. However, EF of the patients with TTC exceeded that of the control subjects on follow-up (56 ± 8%; p = 0.0007). The mIBG imaging showed a lower late (4-h) heart-to-mediastinum ratio (H/Mlate) (2.00 ± 0.38) and a higher washout rate (WR) (45 ± 12%) in the subacute state of TTC, both when compared with follow-up (H/Mlate: 2.42 ± 0.45; p = 0.0004; WR: 33 ± 14%; p = 0.0004) and when compared with the control group in the subacute state (H/Mlate: 2.34 ± 0.60, p = 0.035; WR: 33 ± 19%, p = 0.026). On follow-up, no differences in mIBG parameters were observed between the TTC and control groups (H/Mlate: 2.41 ± 0.51, p = 0.93; WR: 30 ± 13%, p = 0.48) group. In the TTC group, plasma epinephrine levels were elevated in the subacute state (Log2[epinephrine]: 6.13 ± 1.04 pg/ml), both when compared with follow-up (5.25 ± 0.62 pg/ml; p = 0.0004) and when compared with the control group in the subacute state (5.46 ± 0.69 pg/ml; p = 0.044), and these levels remained elevated in the TTC group on follow-up compared with the control group (4.56 ± 0.95 pg/ml; p = 0.014). No significant differences in plasma norepinephrine levels were observed.CONCLUSIONS: The present study supports a possible role of adrenergic hyperactivity in TTC.",

keywords = "Journal Article",

author = "Christensen, {Thomas Emil} and Bang, {Lia Evi} and Lene Holmvang and Skovgaard, {Dorthe Charlotte} and Oturai, {Ditte Bang} and Helle S{\o}holm and Thomsen, {Jakob Hartvig} and Andersson, {Hedvig Bille} and Ghotbi, {Adam Ali} and Nikolaj Ihlemann and Andreas Kjaer and Philip Hasbak",

year = "2016",

month = aug,

day = "1",

doi = "10.1016/j.jcmg.2016.01.028",

language = "English",

volume = "9",

pages = "982--90",

journal = "JACC. Cardiovascular imaging",

issn = "1876-7591",

publisher = "Elsevier",

number = "8",

}

TY - JOUR

T1 - (123)I-MIBG Scintigraphy in the Subacute State of Takotsubo Cardiomyopathy

AU - Christensen, Thomas Emil

AU - Bang, Lia Evi

AU - Holmvang, Lene

AU - Skovgaard, Dorthe Charlotte

AU - Oturai, Ditte Bang

AU - Søholm, Helle

AU - Thomsen, Jakob Hartvig

AU - Andersson, Hedvig Bille

AU - Ghotbi, Adam Ali

AU - Ihlemann, Nikolaj

AU - Kjaer, Andreas

AU - Hasbak, Philip

PY - 2016/8/1

Y1 - 2016/8/1

N2 - OBJECTIVES: The study sought to investigate adrenergic activity in patients with takotsubo cardiomyopathy (TTC).BACKGROUND: TTC is a specific type of reversible heart failure possibly caused by excessive catecholamine stimulation of the myocardium. Scintigraphic iodine-123-meta-iodobenzylguanidine (mIBG) imaging of the heart and measurement of plasma catecholamines can be used to assess adrenergic activity in vivo. The authors hypothesized that sympathetic nerve activity is increased in the subacute state of TTC, and this study used cardiac mIBG imaging and plasma levels of norepinephrine and epinephrine as markers to assess this hypothesis.METHODS: In this study, 32 patients with TTC and 20 controls were examined at admission and again on follow-up with echocardiography, mIBG scintigraphy, and plasma catecholamine measurements.RESULTS: Ejection fraction (EF) was initially 36 ± 9% but increased to >60% (p = 0.0004) in all patients with TTC. In the control subjects EF was initially higher (51 ± 11%; p = 0.0004) than in the patients with TTC. However, EF of the patients with TTC exceeded that of the control subjects on follow-up (56 ± 8%; p = 0.0007). The mIBG imaging showed a lower late (4-h) heart-to-mediastinum ratio (H/Mlate) (2.00 ± 0.38) and a higher washout rate (WR) (45 ± 12%) in the subacute state of TTC, both when compared with follow-up (H/Mlate: 2.42 ± 0.45; p = 0.0004; WR: 33 ± 14%; p = 0.0004) and when compared with the control group in the subacute state (H/Mlate: 2.34 ± 0.60, p = 0.035; WR: 33 ± 19%, p = 0.026). On follow-up, no differences in mIBG parameters were observed between the TTC and control groups (H/Mlate: 2.41 ± 0.51, p = 0.93; WR: 30 ± 13%, p = 0.48) group. In the TTC group, plasma epinephrine levels were elevated in the subacute state (Log2[epinephrine]: 6.13 ± 1.04 pg/ml), both when compared with follow-up (5.25 ± 0.62 pg/ml; p = 0.0004) and when compared with the control group in the subacute state (5.46 ± 0.69 pg/ml; p = 0.044), and these levels remained elevated in the TTC group on follow-up compared with the control group (4.56 ± 0.95 pg/ml; p = 0.014). No significant differences in plasma norepinephrine levels were observed.CONCLUSIONS: The present study supports a possible role of adrenergic hyperactivity in TTC.

AB - OBJECTIVES: The study sought to investigate adrenergic activity in patients with takotsubo cardiomyopathy (TTC).BACKGROUND: TTC is a specific type of reversible heart failure possibly caused by excessive catecholamine stimulation of the myocardium. Scintigraphic iodine-123-meta-iodobenzylguanidine (mIBG) imaging of the heart and measurement of plasma catecholamines can be used to assess adrenergic activity in vivo. The authors hypothesized that sympathetic nerve activity is increased in the subacute state of TTC, and this study used cardiac mIBG imaging and plasma levels of norepinephrine and epinephrine as markers to assess this hypothesis.METHODS: In this study, 32 patients with TTC and 20 controls were examined at admission and again on follow-up with echocardiography, mIBG scintigraphy, and plasma catecholamine measurements.RESULTS: Ejection fraction (EF) was initially 36 ± 9% but increased to >60% (p = 0.0004) in all patients with TTC. In the control subjects EF was initially higher (51 ± 11%; p = 0.0004) than in the patients with TTC. However, EF of the patients with TTC exceeded that of the control subjects on follow-up (56 ± 8%; p = 0.0007). The mIBG imaging showed a lower late (4-h) heart-to-mediastinum ratio (H/Mlate) (2.00 ± 0.38) and a higher washout rate (WR) (45 ± 12%) in the subacute state of TTC, both when compared with follow-up (H/Mlate: 2.42 ± 0.45; p = 0.0004; WR: 33 ± 14%; p = 0.0004) and when compared with the control group in the subacute state (H/Mlate: 2.34 ± 0.60, p = 0.035; WR: 33 ± 19%, p = 0.026). On follow-up, no differences in mIBG parameters were observed between the TTC and control groups (H/Mlate: 2.41 ± 0.51, p = 0.93; WR: 30 ± 13%, p = 0.48) group. In the TTC group, plasma epinephrine levels were elevated in the subacute state (Log2[epinephrine]: 6.13 ± 1.04 pg/ml), both when compared with follow-up (5.25 ± 0.62 pg/ml; p = 0.0004) and when compared with the control group in the subacute state (5.46 ± 0.69 pg/ml; p = 0.044), and these levels remained elevated in the TTC group on follow-up compared with the control group (4.56 ± 0.95 pg/ml; p = 0.014). No significant differences in plasma norepinephrine levels were observed.CONCLUSIONS: The present study supports a possible role of adrenergic hyperactivity in TTC.

KW - Journal Article

U2 - 10.1016/j.jcmg.2016.01.028

DO - 10.1016/j.jcmg.2016.01.028

M3 - Journal article

C2 - 27344416

SN - 1876-7591

VL - 9

SP - 982

EP - 990

JO - JACC. Cardiovascular imaging

JF - JACC. Cardiovascular imaging

IS - 8

ER -

(123)I-MIBG Scintigraphy in the Subacute State of Takotsubo Cardiomyopathy

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