Scintigraphic studies on the etiology of Ampulla Cardiomyopathy.
BACKGROUND
Although there are many reports on Ampulla Cardiomyopathy, its etiologic mechanisms are not well known.


OBJECTIVE
Etiology of Ampulla Cardiomyopathy was investigated by myocardial scintigraphy with various nuclear tracers.


METHODS
In nine patients with Ampulla Cardiomyopathy, myocardial scintigraphy was performed at acute, subacute and chronic phases. Total defect score (TDS) of tallium-201 (Tl) or technetrium-99m sestamibi (MIBI) myocardial perfusion and iodine-123-beta-methyl-p-iodophenyl penta-decanoic acid (BMIPP) scintigraphies was calculated. Cardio-mediastinal ratio (H/M) and washout rate (WR) of early and delayed images of iodine-123-meta-iodobenzylguanidine (MIBG) scintigraphy were also calculated. The patients in whom TDS of myocardial perfusion scintigraphy at acute phase was 0, were classified into group N (n = 5) and those with TDS > or = 1 into group D (n = 4).


RESULTS
TDS of BMIPP at acute, subacute and chronic phases was higher in D than in N; 28.8 +/- 10.3 vs. 7.2 4.7 (p = 0.0039), 15.5 +/- 2.1 vs. 1.0 +/- 0.8 (p < 0.0001) and 2.7 +/- 1.2 vs. 0 (p = 0.05), respectively. WR of MIBG at acute phase was also higher in D (50.3 +/- 5.7% vs. 36.6 +/- 10.5%, p = 0.05). H/M (dH/M) on the delayed images and WR at chronic phase were not different between the two groups. H/M (eH/M) on the early images was lower in D. Blood noradrenaLine (ng/ml) at acute phase was higher in D than in N (1.21 +/- 0.55 vs. 0.45 +/- 0.33, p < 0.05). Left ventricular ejection fraction (LVEF) was decreased in both at acute phase but it was lower in D than in N (48.1 +/- 3.7% vs. 69.9 +/- 9.7%, p < 0.05) at subacute phase.


CONCLUSIONS
These findings suggest that the etiology of Ampulla Cardiomyopathy is neurologically stunned myocardium induced by coronary microcirculatory disorder. Due to the significant amount of time that was necessary for normalization of wall motion in the D group, myocardial scintigraphy is believed to be also useful in assessment of severity.
Division of Cardiovascular Medicine, Department of Internal Medicine, Ohmori Hospital, Toho University School of Medicine, Tokyo, Japan. yasutoyasutouchida@s6.dion.ne.jp
Yasuto
Y
Uchida
Shuji
S
Nanjo
Shinichiro
S
Fujimoto
Shohei
S
Yamashina
Kenji
K
Wagatsma
Hajime
H
Nakano
Junichi
J
Yamazaki
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003327:Coronary Disease / Q000150:complications* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D017682:Myocardial Stunning / Q000000981:diagnostic imaging* / Q000209:etiology*; D011868:Radioisotopes; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012720:Severity of Illness Index
D011868:Radioisotopes; D019275:Radiopharmaceuticals