Serial changes of myocardial perfusion imaging in takotsubo and reverse takotsubo cardiomyopathy

J Nucl Cardiol. 2022 Oct;29(5):2599-2611. doi: 10.1007/s12350-021-02755-y. Epub 2021 Aug 24.

Abstract

Background: Takotsubo cardiomyopathy (TTC) shows reversible hypokinesis in the left ventricular (LV) apical-half segment and hyperkinesis in the LV basal-half segment. However, the precise pathophysiological mechanism of TTC is unclear. Therefore, this study sought to clarify the nuclear characteristics, degree of myocardial damage, and serial change of TTC and rTTC using myocardial perfusion imaging.

Methods: We performed myocardial perfusion scintigraphy in 28 patients (TTC: 20, rTTC: 8) using Tc-99m sestamibi and assessed minimum percentage uptake (min-%-uptake), extent score (ES) and summed rest score (SRS) at acute and chronic phases.

Results: Min-%-uptake improved from the acute to the chronic phase (TTC: 54 [48-59]% vs 87 [81-90]%, P < 0.01; rTTC: 60 [55-64]% vs 77 [71-79]%, P < 0.01), as did the ES (TTC: 32 [26-41]% vs 0.0 [0.0-6.0]%, P < 0.01; rTTC: 16 [12-34]% vs 0.0 [0.0-0.0]%, P = 0.02) and SRS (TTC: 4.5 [3.9-5.3] vs 0.0 [0.0-0.2], P < 0.01; rTTC: 3.6 [3.3-3.8] vs 0.0 [0.0-0.0], P = 0.01).

Conclusion: Tc-99m sestamibi uptake was reduced in hypokinetic regions in the acute phase and improved in the chronic phase. TTC and rTTC may involve a reversible disorder of the myocardial cell membrane, mitochondria, and microcirculation.

Keywords: Extent score; Myocardial perfusion scintigraphy; Reverse takotsubo cardiomyopathy; Takotsubo cardiomyopathy.

MeSH terms

  • Heart Ventricles
  • Humans
  • Myocardial Perfusion Imaging* / methods
  • Takotsubo Cardiomyopathy* / diagnostic imaging
  • Technetium Tc 99m Sestamibi
  • Tomography, X-Ray Computed

Substances

  • Technetium Tc 99m Sestamibi