123I-间碘苄胍心肌闪烁显像在“应激性心肌病”患者中的应用

123I-MIBG myocardial scintigraphy in patients with "takotsubo" cardiomyopathy.

作者信息

Akashi Yoshihiro J, Nakazawa Kiyoshi, Sakakibara Masayoshi, Miyake Fumihiko, Musha Haruki, Sasaka Kaoru

机构信息

Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.

出版信息

J Nucl Med. 2004 Jul;45(7):1121-7.

PMID:15235057

Abstract

UNLABELLED

The clinical characteristics of reversible left ventricular dysfunction due to "takotsubo" cardiomyopathy have been described, but the origin of this condition remains unclear. This study investigated (123)I-metaiodobenzlguanidine ((123)I-MIBG) myocardial scintigraphy in patients with takotsubo cardiomyopathy.

METHODS

Eight consecutive patients with takotsubo cardiomyopathy were studied. Left ventricular wall motion was monitored by echocardiography until wall motion normalized. (123)I-MIBG myocardial scintigrams were performed within 3 d of admission (0 mo) and after the improvement of left ventricular dysfunction (3 mo). Early images were obtained at 30 min after radioisotope injection and delayed images were obtained after 4 h. The heart-to-mediastinum ratio (H/M ratio) and the washout rate were calculated.

RESULTS

The mean left ventricular ejection fraction improved significantly (from 42.8% +/- 8.7% to 66.5% +/- 7.9%; P < 0.0001) and normalized after 19.4 +/- 5.4 hospital days. The early H/M ratio was significantly higher than the late ratio at 0 mo (2.16 +/- 0.25 vs. 1.89 +/- 0.24, respectively; P < 0.05), but not at 3 mo. The washout rate was significantly greater at 0 mo than at 3 mo (39.1% +/- 10.2% vs. 25.4% +/- 6.3%, respectively; P < 0.05).

CONCLUSION

In patients with takotsubo cardiomyopathy, initial (123)I-MIBG myocardial scintigraphy depicted a unique pattern of ventricular asynergy and indicated the existence of cardiac sympathetic hyperactivity, although coronary blood flow was maintained. These findings strongly suggest that takotsubo cardiomyopathy could be caused by neurogenic myocardial stunning.

摘要

未标记

“章鱼壶”心肌病所致可逆性左心室功能障碍的临床特征已有描述，但该病的病因仍不清楚。本研究对章鱼壶心肌病患者进行了（123）I-间碘苄胍（（123）I-MIBG）心肌显像。

方法

对连续8例章鱼壶心肌病患者进行研究。通过超声心动图监测左心室壁运动，直至壁运动恢复正常。在入院后3天内（0个月）和左心室功能障碍改善后（3个月）进行（123）I-MIBG心肌显像。放射性同位素注射后30分钟获得早期图像，4小时后获得延迟图像。计算心/纵隔比（H/M比）和洗脱率。

结果

平均左心室射血分数显著改善（从42.8%±8.7%提高到66.5%±7.9%；P<0.0001），并在19.4±5.4个住院日后恢复正常。0个月时早期H/M比显著高于晚期（分别为2.16±0.25和1.89±0.24；P<0.05），但3个月时无差异。0个月时的洗脱率显著高于3个月时（分别为39.1%±10.2%和25.4%±6.3%；P<0.05）。