European Heart Journal Advance Access originally published online on February 27, 2008
European Heart Journal 2008 29(8):1072-1073; doi:10.1093/eurheartj/ehn065
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pathophysiology of ‘Tako-Tsubo’ cardiomyopathy: collecting pieces of a puzzle: reply
Department of Cardiovascular Medicine
Gifu Prefectural Government Tajimi Hospital
5-161 Maehata
Tajimi
Gifu 5078522
Japan
Tel: +81 572 22 5311
Fax: +81 572 25 1246
Email: tetsuro-moet{at}nifty.com;
p41549{at}govt.pref.gifu.jp
Department of Cardiovascular Medicine
Gifu Prefectural Government Tajimi Hospital
5-161 Maehata
Tajimi
Gifu 5078522
Japan
Department of Radiology
Kizawa Memorial Hospital
Minokamo
Japan
Department of Cardiovascular Medicine
Gifu Prefectural Government Tajimi Hospital
5-161 Maehata
Tajimi
Gifu 5078522
Japan
Department of Cardiovascular Medicine
Gifu Prefectural Government Tajimi Hospital
5-161 Maehata
Tajimi
Gifu 5078522
Japan
Department of Cardiovascular Medicine
Gifu Prefectural Government Tajimi Hospital
5-161 Maehata
Tajimi
Gifu 5078522
Japan
Department of Cardiovascular Medicine
Gifu Prefectural Government Tajimi Hospital
5-161 Maehata
Tajimi
Gifu 5078522
Japan
Department of Cardio-Renal Medicine and Hypertension
Nagoya City University Graduate School of Medical Sciences
Nagoya
Japan
Department of Cardiovascular Medicine
Gifu Prefectural Government Tajimi Hospital
5-161 Maehata
Tajimi
Gifu 5078522
Japan
Department of Cardio-Renal Medicine and Hypertension
Nagoya City University Graduate School of Medical Sciences
Nagoya
Japan
We thank Dr Peter W. Radke and colleagues for showing interest in our work. We are pleased to have the opportunity to reply to his constructive comments. As he suggested, we should investigate the variant forms of Tako-Tsubo cardiomyopathy, such as mid-ventricular ballooning or inverted Tako-Tsubo. We agree with the importance of this issue; however, we have no such data because we never experienced the variant form of Tako-Tsubo cardiomyopathy during the observation period.1 On the other hand, Kurowski et al.2 reported a high frequency of mid-ventricular patterns in patients with Tako-Tsubo cardiomyopathy. The reason for this difference in the frequency between their study and our study may be due to the difference in the number of enrolled patients or patient's characteristics.
We concur with their findings that the perfusion–metabolism mismatch, which has previously been suggested in some case reports with use of F-18 fluorodeoxyglucose positron emission tomography (FDG-PET),3,4 may play a key role in the mechanism underlying Tako-Tsubo cardiomyopathy. We have particular interest in their F18-FDG-PET findings of the patients with a mid-ventricular pattern. In addition, this phenomenon may imply a close relationship between a glucose metabolic disorder and the onset of Tako-Tsubo cardiomyopathy, although we did not evaluate glucose metabolism in patients with Tako-Tsubo cardiomyopahy during the chronic phase differently from the previous study. Therefore, their excellent work extends the understanding of our findings.
There are no studies, which have confirmed the true mechanism underlying Tako-Tsubo cardiomyopathy, although many interesting reports have been published worldwide. Further investigation, such as a large-scale study in collaboration with many investigators in various countries, is required to confirm that a glucose metabolism disorder in the myocardium may reflect the root cause or a secondary response in patients with Tako-Tsubo cardiomopathy, as well as the true underlying mechanism.
References
- Yoshida T, Hibino T, Kako N, Murai S, Oguri M, Kato K, Yajima K, Ohte N, Yokoi K, Kimura G. A pathophysiologic study of tako-tsubo cardiomyopathy with F-18 fluorodeoxyglucose positron emission tomography. Eur Heart J (2007) 28:2598–2604.
[Abstract/Free Full Text] - Kurowski V, Kaiser A, von Hof K, Killermann DP, Mayer B, Hartmann F, Schunkert H, Radke PW. Apical and midventricular transient left ventricular dysfunction syndrome (tako-tsubo cardiomyopathy): frequency, mechanisms, and prognosis. Chest (2007) 132:809–816.[CrossRef][Web of Science][Medline]
- Obunai K, Misra D, Van Tosh A, Bergmann SR. Metabolic evidence of myocardial stunning in takotsubo cardiomyopathy: a positron emission tomography study. J Nucl Cardiol (2005) 12:742–744.[CrossRef][Web of Science][Medline]
- Bybee KA, Murphy J, Prasad A, Wright RS, Lerman A, Rihal CS, Chareonthaitawee P. Acute impairment of regional myocardial glucose uptake in the apical ballooning (takotsubo) syndrome. J Nucl Cardiol (2006) 13:244–250.[CrossRef][Web of Science][Medline]
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||