title: A pathophysiologic study of tako-tsubo cardiomyopathy with F-18 fluorodeoxyglucose positron emission tomography.
abstract: AIMS; Our study aims to investigate the pathophysiologic mechanism underlying tako-tsubo cardiomyopathy using F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET).
  
  
  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 ((201)Tl) 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 (201)Tl. Elevation of D-dimer was observed in nine patients.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Cardiovascular Medicine, Gifu Prefectural Government Tajimi Hospital, 5-161 Maehata, Tajimi, Gifu 5078522, Japan. tetsuro-moet@nifty.com
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Yoshida
authors.forename: Takeshi
authors.initials: T
authors.lastname: Hibino
authors.forename: Nobuo
authors.initials: N
authors.lastname: Kako
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Murai
authors.forename: Mitsutoshi
authors.initials: M
authors.lastname: Oguri
authors.forename: Kimihiko
authors.initials: K
authors.lastname: Kato
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Yajima
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Ohte
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Yokoi
authors.forename: Genjiro
authors.initials: G
authors.lastname: Kimura
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D006328:Cardiac Catheterization / Q000379:methods; D002395:Catecholamines / Q000097:blood; D017023:Coronary Angiography / Q000379:methods; D004452:Echocardiography / Q000379:methods; D004562:Electrocardiography / Q000379:methods; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D049268:Positron-Emission Tomography / Q000379:methods*; D019275:Radiopharmaceuticals; D054549:Takotsubo Cardiomyopathy / Q000000981:diagnostic imaging* / Q000209:etiology / Q000378:metabolism; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D020107:Troponin T / Q000097:blood
chemical_list: D015415:Biomarkers; D002395:Catecholamines; D005338:Fibrin Fibrinogen Degradation Products; D019275:Radiopharmaceuticals; D013794:Thallium Radioisotopes; D020107:Troponin T; C036309:fibrin fragment D; D019788:Fluorodeoxyglucose F18