title: Reversible impairment of coronary flow reserve in takotsubo cardiomyopathy: a myocardial PET study.
abstract: BACKGROUND
  The precise etiology of takotsubo cardiomyopathy remains unclear. The study of myocardial blood flow (MBF) and coronary flow reserve (CFR) by use of positron emission tomography might help in understanding this syndrome.
  
  
  RESULTS
  Three postmenopausal women underwent adenosine/rest perfusion with nitrogen 13 ammonia and metabolism with fluorine 18 fluorodeoxyglucose positron emission tomography, coronary angiography, cardiac magnetic resonance, and echocardiography in the acute phase of takotsubo cardiomyopathy and at 3 months' follow-up, after normalization of left ventricular function. PET study was performed in 2 parts: the perfusion analysis with nitrogen ammonia and the metabolism of the heart using FDG. MBF and CFR were analyzed quantitatively in the acute phase and at follow-up. The images highlighted the impairment of tissue metabolism in the dysfunctioning left ventricular segments in the acute phase, mainly in the apical segments and progressively less in the medium segments. At the same time, a clear inverse metabolic/perfusion mismatch emerged, which normalized 3 months later. The quantitative analysis of MBF showed a reduction in the acute phase in apical segments in comparison to basal segments without differences between midventricular and basal segments. In the acute phase CFR proved to be reduced in apical versus basal segments. CFR impairment of apical segments recovered completely after 3 months.
  
  
  CONCLUSIONS
  The acute phase of takotsubo cardiomyopathy is characterized by an inverse perfusion/metabolism mismatch with a reduction in CFR in the apical segments. However, the impairment of CFR and the reduction of metabolism in the apical segments recovered completely after 3 months.
authors.affiliation: Department of Cardiovascular Diseases, Ospedale Santa Croce-Carle Cuneo, Cuneo, Italy. m_feola@virgilio.it
authors.forename: Mauro
authors.initials: M
authors.lastname: Feola
authors.forename: Stephane
authors.initials: S
authors.lastname: Chauvie
authors.forename: Gian Luca
authors.initials: GL
authors.lastname: Rosso
authors.forename: Alberto
authors.initials: A
authors.lastname: Biggi
authors.forename: Flavio
authors.initials: F
authors.lastname: Ribichini
authors.forename: Marco
authors.initials: M
authors.lastname: Bobbio
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity; D017023:Coronary Angiography / Q000379:methods; D004452:Echocardiography / Q000379:methods; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000494:pharmacology; D006801:Humans; D007700:Kinetics; D008279:Magnetic Resonance Imaging / Q000379:methods; D009206:Myocardium / Q000473:pathology*; D049268:Positron-Emission Tomography / Q000379:methods; D011868:Radioisotopes / Q000494:pharmacology; D013577:Syndrome; D054549:Takotsubo Cardiomyopathy / Q000175:diagnosis* / Q000473:pathology
chemical_list: D011868:Radioisotopes; D019788:Fluorodeoxyglucose F18