title: The natural history of takotsubo syndrome: a two-year follow-up study with myocardial sympathetic and perfusion G-SPECT imaging.
abstract: OBJECTIVE
  To investigate changes in sympathetic activity, perfusion, and left ventricular (LV) functionality in takotsubo cardiomyopathy (TTC) patients from onset (T0) to post-onset conditions at 1 month (T1), 1-2 years (T2, T3).
  
  
  METHODS
  Twenty-two patients (70 ± 11 years) underwent serial gated single photon emission tomography (G-SPECT) studies with123I-mIBG and99mTc-Sestamibi. Statistics were performed using ANOVA/Sheffé post-hoc, correlation test, and receiver operating characteristic (ROC) curve analysis (p < 0.05).
  
  
  RESULTS
  Patients presented at T0with LV ballooning and reduced early-late mIBG uptake (95%, 100%), left ventricular ejection fraction (LVEF)G-SPECT(86%) and perfusion (77 %). Adrenergic dysfunction was greater in apex, it overlaps with contractile impairment, and both were more severe than perfusion defect. During follow-up, LVEFG-SPECT, contractility, and perfusion were normal, while 82% and 90% of patients at T1and 50% at T2and T3continued to show a reduced apical early-late mIBG distribution. These patients presented at T0-T1with greater impairment of adrenergic function, contractility, and perfusion. A relationship was present within innervation and both perfusion and contractile parameters at T0and T1, and between the extent of adrenergic defect at T3and both the defect extent and age at T0(cut-off point 42.5%, 72 years).
  
  
  CONCLUSIONS
  Outcome for TTC is not limited to a reversible contractile and perfusion abnormalities, but it includes residual adrenergic dysfunction, depending on the level of adrenergic impairment and age of patients at onset. The number of patients, as well as degree of perfusion abnormalities were found to be higher than those previously reported possibly depending on the time-interval between hospital admission and perfusion scan.
authors.affiliation: Deptartment of Diagnostic Imaging, Nuclear Medicine Unit, N.O.P. - S. Stefano, U.S.L. Toscana Centro, via Suor Niccolina Infermiera 20, 59100, Prato, Italy. stelvio.sestini@uslcentro.toscana.it.
authors.forename: Stelvio
authors.initials: S
authors.lastname: Sestini
authors.affiliation: Deptartment of Internal Medicine, Cardiovascular Unit, N.O.P. - S. Stefano, U.S.L, Toscana Centro, Prato, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Pestelli
authors.affiliation: Deptartment of Internal Medicine, Cardiovascular Unit, N.O.P. - S. Stefano, U.S.L, Toscana Centro, Prato, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Leoncini
authors.affiliation: Deptartment of Internal Medicine, Cardiovascular Unit, N.O.P. - S. Stefano, U.S.L, Toscana Centro, Prato, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Bellandi
authors.affiliation: Deptartment of Diagnostic Imaging, Nuclear Medicine Unit, N.O.P. - S. Stefano, U.S.L. Toscana Centro, via Suor Niccolina Infermiera 20, 59100, Prato, Italy.
authors.forename: Christian
authors.initials: C
authors.lastname: Mazzeo
authors.affiliation: Deptartment of Diagnostic Imaging, Nuclear Medicine Unit, University II Naples, Naples, Italy.
authors.forename: Luigi
authors.identifier: http://orcid.org/0000-0001-8258-5134
authors.initials: L
authors.lastname: Mansi
authors.affiliation: Nuclear Medicine, Hospital Sant Pau, Barcelona, Spain.
authors.forename: Ignasi
authors.initials: I
authors.lastname: Carrio
authors.affiliation: Deptartment of Diagnostic Imaging, Nuclear Medicine Unit, N.O.P. - S. Stefano, U.S.L. Toscana Centro, via Suor Niccolina Infermiera 20, 59100, Prato, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Castagnoli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001342:Autonomic Nervous System Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D018450:Disease Progression; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D015637:Gated Blood-Pool Imaging / Q000379:methods*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D013315:Stress, Psychological / Q000150:complications / Q000000981:diagnostic imaging*; D054549:Takotsubo Cardiomyopathy / Q000150:complications / Q000000981:diagnostic imaging*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology
keywords: Myocardial perfusion; Takotsubo syndrome; mIBG