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European Heart Journal Advance Access published online on October 7, 2007
European Heart Journal, doi:10.1093/eurheartj/ehm401
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org
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A pathophysiologic study of tako-tsubo cardiomyopathy with F-18 fluorodeoxyglucose positron emission tomography

Tetsuro Yoshida1,*, Takeshi Hibino1, Nobuo Kako2, Shunsuke Murai1, Mitsutoshi Oguri1, Kimihiko Kato1, Kazuhiro Yajima1, Nobuyuki Ohte3, Kiyoshi Yokoi1 and Genjiro Kimura3

1 Department of Cardiovascular Medicine, Gifu Prefectural Government Tajimi Hospital, 5-161 Maehata, Tajimi, Gifu 5078522, Japan
2 Department of Radiology, Kizawa Memorial Hospital, Minokamo, Japan
3 Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan

* Corresponding author. Tel: +81 572 22 5311; fax: +81 572 25 1246. E-mail address: tetsuro-moet{at}nifty.com

Aims: Our study aims to investigate the pathophysiologic mechanism underlying tako-tsubo cardiomyopathy using F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET).

Methods and results: Fifteen patients with tako-tsubo cardiomyopathy were enrolled in this study. Plasma catecholamines, cardiac troponin T (cTnT), and D-dimer were serially evaluated in all patients. Thallium-201 (201Tl) single-photon emission computed tomography (SPECT) and F-18 FDG PET were performed in 10 and eight patients, respectively. Emotional or physical stress occurred in 12 (80.0%) patients. ST-T segment abnormalities existed in all patients. Thirteen patients exhibited mildly elevated cTnT, although coronary angiography did not reveal significant stenosis in any patient. Endomyocardial biopsy specimens (n = 9) demonstrated contraction-band necrosis (n = 4) and mononuclear cell infiltration (n = 3). The levels of norepinephrine and epinephrine peaked on admission (744 ± 452 and 140 ± 166 pg/mL, respectively). There was severely reduced uptake at the apex on F-18 FDG PET image, despite slightly reduced uptake of 201Tl. Elevation of D-dimer was observed in nine patients.

Conclusion: The extent of metabolic defect involving apical akinetic area was more severe than perfusion abnormality. Our data suggest that sudden emotional or physical stress may cause a catecholamine-induced metabolic disorder in the myocardium, which is probably central to this syndrome.

Key Words: Tako-tsubo cardiomyopathy • Catecholamine-induced metabolic disorder • F-18 fluorodeoxyglucose positron emission tomography


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