Assessment of ampulla (Takotsubo) cardiomyopathy with coronary angiography, two-dimensional echocardiography and 99mTc-tetrofosmin myocardial single photon emission computed tomography.
We studied the causative mechanism of ampulla (Takotsubo) cardiomyopathy.


METHODS
We examined 7 patients with ampulla cardiomyopathy by means of coronary angiography, two-dimensional echocardiography and 99Tc-tetrofosmin myocardial SPECT at the time of emergency admission (acute phase), at 3 to 5 days after the attack (subacute phase) and at 1 month after the attack (chronic phase). The left ventricle was divided into 9 regions on two-dimensional echocardiograms and 99mTc-tetrofosmin myocardial SPECT images, then the degree of abnormalities in each region was scored in four grades from normal (0) to severely abnormal (3). We injected nicorandil into the coronary arteries and determined the elevation in the ST segment before and after administration.


RESULTS
Coronary angiography did not show stenotic lesions in any patient. The acute, subacute and chronic phase myocardial perfusion scores on 99mTc-tetrofosmin myocardial SPECT were 11.2 +/- 3.4, 2.7 +/- 2.3 and 0.4 +/- 0.5, respectively, and wall motion scores on echocardiograms were 13.0 +/- 3.6, 4.4 +/- 2.2 and 0.6 +/- 0.6, respectively, indicating improvement in all scores during the subacute phase (p < 0.01). The elevation in the ST segment (mm) on the electrocardiogram was improved from 8.3 +/- 2.7 to 4.9 +/- 1.9 after the administration of nicorandil (p < 0.05).


CONCLUSIONS
These findings indicated that coronary microvascular spasm is one causative mechanism of ampulla cardiomyopathy.
Ito
K
K
Division of Cardiology, Murakami Memorial Hospital, Asahi University, Japan. kazuki@poppy.ocn.ne.jp
Sugihara
H
H
Kawasaki
T
T
Yuba
T
T
Doue
T
T
Tanabe
T
T
Adachi
Y
Y
Katoh
S
S
Azuma
A
A
Nakagawa
M
M
D000208:Acute Disease; D000368:Aged; D009202:Cardiomyopathies / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D002908:Chronic Disease; D017023:Coronary Angiography; D003329:Coronary Vasospasm / Q000150:complications; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D015899:Tomography, Emission-Computed, Single-Photon
D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C078700:technetium tc-99m tetrofosmin