Cardiac 99mTc sestamibi SPECT and 18F FDG PET as viability markers in takotsubo cardiomyopathy

Thomas Emil Christensen; Lia Evi Bang; Lene Holmvang; Adam Ali Ghotbi; Martin Lyngby Lassen; Flemming Andersen; Nikolaj Ihlemann; Hedvig Andersson; Peer Grande; Andreas Kjaer; Philip Hasbak

doi:10.1007/s10554-014-0453-5

Cardiac^99mTc sestamibi SPECT and ¹⁸F FDG PET as viability markers in takotsubo cardiomyopathy

Thomas Emil Christensen, Lia Evi Bang, Lene Holmvang, Adam Ali Ghotbi, Martin Lyngby Lassen, Flemming Andersen, Nikolaj Ihlemann, Hedvig Andersson, Peer Grande, Andreas Kjaer, Philip Hasbak

15 Citations (Scopus)

Abstract

In patients with heart failure (HF) due to coronary disease, a combined evaluation of perfusion and glucose metabolism by cardiac single photon emission computed tomography (SPECT)/positron emission tomography (PET) can be used to distinguish viable from non-viable myocardium, and current guidelines recommend cardiac SPECT and fluorodeoxyglucose (FDG) PET for viability assessment. Takotsubo cardiomyopathy (TTC) is a disease characterized by acute but reversible HF leaving no scarring. To explore how robust the semi-quantitative viability criteria used in cardiac SPECT and FDG PET stands their ground in a population with TTC. From 1 September 2009 to 1 October 2012, 24 patients suspected of TTC were enrolled in a multimodality cardiac imaging research project. Echocardiography, (99m)Tc SPECT, and (18)F FDG PET were performed during the acute admission and at follow-up 4 months later. Nineteen patients had a final diagnosis of TTC consistent with Mayo Clinic Diagnostic Criteria. Three of these patients were excluded from further analysis, since wall motion abnormalities were not persistent at the time of nuclear imaging. The remaining sixteen patients exhibited a distinct pattern with HF, "apical ballooning" and a perfusion-metabolism defect in the midventricular/apical region. When viability criteria were applied, they identified significant scarring/limited hibernation in the akinetic part of the left ventricle. However, full recovery was found in all TTC patients on follow-up. Using the current guideline-endorsed viability criteria for semiquantitative cardiac SPECT and FDG PET, these modalities failed to demonstrate the presence of viability in the acute state of TTC.

Original language	English
Journal	International Journal of Cardiovascular Imaging
Volume	30
Issue number	7
Pages (from-to)	1407-1416
Number of pages	10
ISSN	1569-5794
DOIs	https://doi.org/10.1007/s10554-014-0453-5
Publication status	Published - Oct 2014

Keywords

Aged
Coronary Angiography
Denmark
Female
Fluorodeoxyglucose F18
Heart Ventricles
Humans
Male
Myocardial Contraction
Positron-Emission Tomography
Predictive Value of Tests
Prognosis
Radiopharmaceuticals
Recovery of Function
Takotsubo Cardiomyopathy
Technetium Tc 99m Sestamibi
Time Factors
Tissue Survival
Tomography, Emission-Computed, Single-Photon
Ventricular Function, Left

Access to Document

10.1007/s10554-014-0453-5

Cite this

@article{afcff43124884a298e569e82a17a1610,

title = "Cardiac 99mTc sestamibi SPECT and 18F FDG PET as viability markers in takotsubo cardiomyopathy",

abstract = "In patients with heart failure (HF) due to coronary disease, a combined evaluation of perfusion and glucose metabolism by cardiac single photon emission computed tomography (SPECT)/positron emission tomography (PET) can be used to distinguish viable from non-viable myocardium, and current guidelines recommend cardiac SPECT and fluorodeoxyglucose (FDG) PET for viability assessment. Takotsubo cardiomyopathy (TTC) is a disease characterized by acute but reversible HF leaving no scarring. To explore how robust the semi-quantitative viability criteria used in cardiac SPECT and FDG PET stands their ground in a population with TTC. From 1 September 2009 to 1 October 2012, 24 patients suspected of TTC were enrolled in a multimodality cardiac imaging research project. Echocardiography, (99m)Tc SPECT, and (18)F FDG PET were performed during the acute admission and at follow-up 4 months later. Nineteen patients had a final diagnosis of TTC consistent with Mayo Clinic Diagnostic Criteria. Three of these patients were excluded from further analysis, since wall motion abnormalities were not persistent at the time of nuclear imaging. The remaining sixteen patients exhibited a distinct pattern with HF, {"}apical ballooning{"} and a perfusion-metabolism defect in the midventricular/apical region. When viability criteria were applied, they identified significant scarring/limited hibernation in the akinetic part of the left ventricle. However, full recovery was found in all TTC patients on follow-up. Using the current guideline-endorsed viability criteria for semiquantitative cardiac SPECT and FDG PET, these modalities failed to demonstrate the presence of viability in the acute state of TTC.",

keywords = "Aged, Coronary Angiography, Denmark, Female, Fluorodeoxyglucose F18, Heart Ventricles, Humans, Male, Myocardial Contraction, Positron-Emission Tomography, Predictive Value of Tests, Prognosis, Radiopharmaceuticals, Recovery of Function, Takotsubo Cardiomyopathy, Technetium Tc 99m Sestamibi, Time Factors, Tissue Survival, Tomography, Emission-Computed, Single-Photon, Ventricular Function, Left",

author = "Christensen, {Thomas Emil} and Bang, {Lia Evi} and Lene Holmvang and Ghotbi, {Adam Ali} and Lassen, {Martin Lyngby} and Flemming Andersen and Nikolaj Ihlemann and Hedvig Andersson and Peer Grande and Andreas Kjaer and Philip Hasbak",

year = "2014",

month = oct,

doi = "10.1007/s10554-014-0453-5",

language = "English",

volume = "30",

pages = "1407--1416",

journal = "International Journal of Cardiovascular Imaging",

issn = "1569-5794",

publisher = "Springer",

number = "7",

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TY - JOUR

T1 - Cardiac 99mTc sestamibi SPECT and 18F FDG PET as viability markers in takotsubo cardiomyopathy

AU - Christensen, Thomas Emil

AU - Bang, Lia Evi

AU - Holmvang, Lene

AU - Ghotbi, Adam Ali

AU - Lassen, Martin Lyngby

AU - Andersen, Flemming

AU - Ihlemann, Nikolaj

AU - Andersson, Hedvig

AU - Grande, Peer

AU - Kjaer, Andreas

AU - Hasbak, Philip

PY - 2014/10

Y1 - 2014/10

N2 - In patients with heart failure (HF) due to coronary disease, a combined evaluation of perfusion and glucose metabolism by cardiac single photon emission computed tomography (SPECT)/positron emission tomography (PET) can be used to distinguish viable from non-viable myocardium, and current guidelines recommend cardiac SPECT and fluorodeoxyglucose (FDG) PET for viability assessment. Takotsubo cardiomyopathy (TTC) is a disease characterized by acute but reversible HF leaving no scarring. To explore how robust the semi-quantitative viability criteria used in cardiac SPECT and FDG PET stands their ground in a population with TTC. From 1 September 2009 to 1 October 2012, 24 patients suspected of TTC were enrolled in a multimodality cardiac imaging research project. Echocardiography, (99m)Tc SPECT, and (18)F FDG PET were performed during the acute admission and at follow-up 4 months later. Nineteen patients had a final diagnosis of TTC consistent with Mayo Clinic Diagnostic Criteria. Three of these patients were excluded from further analysis, since wall motion abnormalities were not persistent at the time of nuclear imaging. The remaining sixteen patients exhibited a distinct pattern with HF, "apical ballooning" and a perfusion-metabolism defect in the midventricular/apical region. When viability criteria were applied, they identified significant scarring/limited hibernation in the akinetic part of the left ventricle. However, full recovery was found in all TTC patients on follow-up. Using the current guideline-endorsed viability criteria for semiquantitative cardiac SPECT and FDG PET, these modalities failed to demonstrate the presence of viability in the acute state of TTC.

AB - In patients with heart failure (HF) due to coronary disease, a combined evaluation of perfusion and glucose metabolism by cardiac single photon emission computed tomography (SPECT)/positron emission tomography (PET) can be used to distinguish viable from non-viable myocardium, and current guidelines recommend cardiac SPECT and fluorodeoxyglucose (FDG) PET for viability assessment. Takotsubo cardiomyopathy (TTC) is a disease characterized by acute but reversible HF leaving no scarring. To explore how robust the semi-quantitative viability criteria used in cardiac SPECT and FDG PET stands their ground in a population with TTC. From 1 September 2009 to 1 October 2012, 24 patients suspected of TTC were enrolled in a multimodality cardiac imaging research project. Echocardiography, (99m)Tc SPECT, and (18)F FDG PET were performed during the acute admission and at follow-up 4 months later. Nineteen patients had a final diagnosis of TTC consistent with Mayo Clinic Diagnostic Criteria. Three of these patients were excluded from further analysis, since wall motion abnormalities were not persistent at the time of nuclear imaging. The remaining sixteen patients exhibited a distinct pattern with HF, "apical ballooning" and a perfusion-metabolism defect in the midventricular/apical region. When viability criteria were applied, they identified significant scarring/limited hibernation in the akinetic part of the left ventricle. However, full recovery was found in all TTC patients on follow-up. Using the current guideline-endorsed viability criteria for semiquantitative cardiac SPECT and FDG PET, these modalities failed to demonstrate the presence of viability in the acute state of TTC.

KW - Aged

KW - Coronary Angiography

KW - Denmark

KW - Female

KW - Fluorodeoxyglucose F18

KW - Heart Ventricles

KW - Humans

KW - Male

KW - Myocardial Contraction

KW - Positron-Emission Tomography

KW - Predictive Value of Tests

KW - Prognosis

KW - Radiopharmaceuticals

KW - Recovery of Function

KW - Takotsubo Cardiomyopathy

KW - Technetium Tc 99m Sestamibi

KW - Time Factors

KW - Tissue Survival

KW - Tomography, Emission-Computed, Single-Photon

KW - Ventricular Function, Left

U2 - 10.1007/s10554-014-0453-5

DO - 10.1007/s10554-014-0453-5

M3 - Journal article

C2 - 24852336

SN - 1569-5794

VL - 30

SP - 1407

EP - 1416

JO - International Journal of Cardiovascular Imaging

JF - International Journal of Cardiovascular Imaging

IS - 7

ER -