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Assessment of takotsubo (ampulla) cardiomyopathy using iodine-123 metaiodobenzylguanidine scintigraphy

2006; SAGE Publishing; Volume: 47; Issue: 10 Linguagem: Inglês

10.1080/02841850600928482

1600-0455

Pinheiro M. C. Pessoa, Salles S. Xavier, Samuel Machado Santos Lima, Jorge Eduardo Mansur, Altino S. de Almeida, Pires A. C. Carvalho, Bianca Gutfilen, Barbosa L. M. da Fonseca,

Pericarditis and Cardiac Tamponade

Purpose: To evaluate the role of cardiac sympathetic innervation in patients whose clinical features consisted of chest pain, transient ST-segment elevation, left ventricular apical akinesis, minimal elevation of cardiac enzymes, and onset of symptoms shortly after a severe stress condition. Material and Methods: Five female patients, mean age 67±14 years, underwent thoracic 123 I-MIBG (planar and SPECT) and 67 Ga citrate (planar) scans within 5 days after the onset of symptoms. The 123 I-MIBG myocardial washout rate between early (30 min) and delayed (3 hours) planar images was calculated. All patients presented findings consistent with takotsubo-like syndrome. Echocardiograms showed the characteristic wall motion pattern of significant apical dysfunction. Acute-phase coronary angiographies revealed a non-obstructive pattern. A peculiar apical akinesis and basal normokinesis were observed on the ventriculograms. Results: Impairment of cardiac neuronal uptake of 123 I-MIBG based on a reduction of the heart-to-mediastinum uptake ratio was observed in all patients, while the washout rate was raised in four patients. All patients presented an apical uptake defect in the 123 I-MIBG SPECT and planar images and a normal 67 Ga scintigraphy. Conclusion: Our data indicate that ampulla cardiomyopathy (AC) is associated with a cardiac sympathetic innervation deficit characterized by a reduced global 123 I-MIBG uptake and an apical uptake defect. The lack of 67 Ga uptake in the acute phase of this syndrome indicates that AC is probably not associated with an inflammatory process.