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


METHODS
Five female patients, mean age 67+/-14 years, underwent thoracic 123I-MIBG (planar and SPECT) and 67Ga citrate (planar) scans within 5 days after the onset of symptoms. The 123I-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 123I-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 123I-MIBG SPECT and planar images and a normal 67Ga scintigraphy.


CONCLUSIONS
Our data indicate that ampulla cardiomyopathy (AC) is associated with a cardiac sympathetic innervation deficit characterized by a reduced global 123I-MIBG uptake and an apical uptake defect. The lack of 67Ga uptake in the acute phase of this syndrome indicates that AC is probably not associated with an inflammatory process.
Pessoa
Pinheiro M C
PM
Departamento de Radiologia, Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Xavier
Salles S
SS
Lima
Souza Leão R
SL
Mansur
J
J
de Almeida
Altino S
AS
Carvalho
Pires A C
PA
Gutfilen
B
B
da Fonseca
Barbosa L M
BL
D019797:3-Iodobenzylguanidine; D000368:Aged; D009202:Cardiomyopathies / Q000000981:diagnostic imaging*; D002951:Citrates; D017023:Coronary Angiography; D004452:Echocardiography; D005260:Female; D005708:Gallium; D006801:Humans; D008875:Middle Aged; D017682:Myocardial Stunning / Q000000981:diagnostic imaging*; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D013577:Syndrome; D015899:Tomography, Emission-Computed, Single-Photon; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*
D002951:Citrates; D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine; D005708:Gallium; C103850:gallium citrate