title: Importance of inflammation and neurohumoral activation in Takotsubo cardiomyopathy.
abstract: BACKGROUND
  To gain more insight into the involvement of inflammatory response and neurohumoral activation in Takotsubo cardiomyopathy (TTC), we investigated C-reactive protein (CRP), leukocytes, plasma catecholamines levels, iodine 123 meta-iodobenzylguanidine (123I-mIBG) myocardial uptake, myocardial perfusion (thallium 201 [201Tl] or technetium [Tc] 99m-tetrofosmin myocardial single photon emission computed tomography [SPECT]), and metabolism (fluorine 18-fluorodeoxyglucose positron emission tomography).
  
  
  RESULTS
  Inflammatory status and brain natriuretic peptide (BNP) levels in 17 patients with TTC were compared with 14 age-matched patients. In TTC, elevated levels of CRP were evidenced on admission, reaching a peak in the following days (P < .01). CRP levels were correlated to baseline left ventricular ejection fraction (LVEF) and BNP levels (P < .05). Leukocytes were correlated to BNP and noradrenaline levels. Myocardial 123I-mIBG SPECT showed a reduced activity in the midventricle and apex corresponding to 35% +/- 23% of the total myocardial mass, partially reversible at follow-up. An identical pattern was retrieved when assessing myocardial glucose metabolism. At rest, no relevant abnormalities of myocardial perfusion could be evidenced at the subacute phase.
  
  
  CONCLUSIONS
  Inflammatory status in TTC was related to LVEF impairment and to the extent of neurohormonal activation. The hypothesis of a catecholamine-induced myocardial "stunning" is emphasized by the evidence of a reduced 123I-mIBG myocardial activity, impairment of myocardial glucose metabolism, and wall motion kinetic after the same temporospatial distribution.
authors.affiliation: Pôle d'Activité Médico-Chirurgicale des Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Morel
authors.forename: Frédérique
authors.initials: F
authors.lastname: Sauer
authors.forename: Alessio
authors.initials: A
authors.lastname: Imperiale
authors.forename: Sébastien
authors.initials: S
authors.lastname: Cimarelli
authors.forename: Cyrille
authors.initials: C
authors.lastname: Blondet
authors.forename: Laurence
authors.initials: L
authors.lastname: Jesel
authors.forename: Annie
authors.initials: A
authors.lastname: Trinh
authors.forename: Fabien
authors.initials: F
authors.lastname: De Poli
authors.forename: Patrick
authors.initials: P
authors.lastname: Ohlmann
authors.forename: André
authors.initials: A
authors.lastname: Constantinesco
authors.forename: Pierre
authors.initials: P
authors.lastname: Bareiss