title: Functional derangement and cardiac innervation in the apical ballooning syndrome: a 123I-meta-iodobenzylguanidine scintigraphic and dobutamine stress echocardiographic study.
abstract: Several cases of transient left ventricular apical ballooning syndrome have already been described, but the pathophysiological mechanisms of this syndrome still remain unclear. We report the case of a patient evaluated in the acute phase of apical ballooning by coronary angiography and echocardiography who was submitted to I-meta-iodobenzylguanidine (MIBG) myocardial scintigraphy and dobutamine stress echocardiography one month after the discharge. MIBG scintigraphy demonstrated a decreased tracer uptake in the apical and periapical anterior regions, whilst myocardial perfusion at rest was normal. Dobutamine induced an increased left ventricular outflow tract gradient and hypokinesis in the apical and periapical segments, mimicking the findings that occurred in the acute phase, and in agreement with the location of MIBG abnormalities. After a two-month treatment with carvedilol, MIBG uptake increased in the apical and periapical anterior regions.
authors.affiliation: Cardiology Department, Niguarda Ca' Granda Hospital, Milan, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Moreo
authors.forename: Benedetta
authors.initials: B
authors.lastname: De Chiara
authors.forename: Mario
authors.initials: M
authors.lastname: Possa
authors.forename: Roberto
authors.initials: R
authors.lastname: Sara
authors.forename: Irene
authors.initials: I
authors.lastname: Bossi
authors.forename: Pedro Silva
authors.initials: PS
authors.lastname: Orrego
authors.forename: Elisa
authors.initials: E
authors.lastname: Nicolosi
authors.forename: Francesco
authors.initials: F
authors.lastname: Mauri
authors.forename: Oberdan
authors.initials: O
authors.lastname: Parodi
mesh_terms: D019797:3-Iodobenzylguanidine; D000368:Aged; D017023:Coronary Angiography; D025401:Echocardiography, Stress; D004562:Electrocardiography; D005260:Female; D006801:Humans; D015425:Myocardial Reperfusion; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D013577:Syndrome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology*
chemical_list: D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine