Ito Kazuki, Sugihara Hiroki, Kinoshita Noriyuki, Azuma Akihiro, Matsubara Hiroaki
Division of Cardiology, Takeda Hospita, Kyoto, Japan.
Ann Nucl Med. 2005 Sep;19(6):435-45. doi: 10.1007/BF02985570.
We compared Takotsubo cardiomyopathy (transient left ventricular apical ballooning) with acute myocardial infarction (AMI) using two-dimensional echocardiography, 99mTc-tetrofosmin, 99mTc-PYP, 123I-BMIPP and 123I-MIBG myocardial SPECT.
We examined 7 patients with Takotsubo cardiomyopathy and 7 with AMI at the time of emergency admission (acute phase), and 2-14 days (subacute phase), one month (chronic phase), and 3 months (chronic II phase) after the attack. The left ventricle was divided into nine regions on echocardiograms and SPECT images, and the degree of abnormalities in each region was scored according to five grades from normal (0) to severely abnormal (4).
Coronary angiography showed the absence of stenotic regions in patients with Takotsubo cardiomyopathy, and severely stenotic and/or occlusive lesions in patients with AMI. The total ST segment elevation on electrocardiograms (mm) was 7.8 +/- 3.7 in those with Takotsubo cardiomyopathy, and 7.3 +/- 3.9 in patients with AMI. Abnormal wall motion scores on echocardiograms were 14.2 +/- 4.6, 4.7 +/- 4.0, 1.7 +/- 2.0 and 0.5 +/- 0.4 during the acute, subacute, chronic and chronic II phases, respectively, in patients with Takotsubo cardiomyopathy, and 14.0 +/- 4.3, 11.4 +/- 3.9, 8.8 +/- 3.6 and 5.2 +/- 4.8 in those with AMI. Abnormal myocardial perfusion scores on 99mTc-tetrofosmin images were 11.8 +/- 3.5, 3.2 +/- 3.0, 0.5 +/- 1.2 and 0.2 +/- 0.4 during the acute, subacute, chronic and chronic II phases, in patients with Takotsubo cardiomyopathy, and 16.2 +/- 4.3, 13.9 +/- 4.6, 7.9 +/- 4.6 and 5.0 +/- 4.5, respectively, in those with AMI. Abnormal myocardial fatty acid scores on 123I-BMIPP images were 12.6 +/- 3.7, 6.8 +/- 3.2 and 0.4 +/- 0.6 during the subacute, chronic and chronic II phases, respectively, in patients with Takotsubo cardiomyopathy, and 16.5 +/- 5.1, 14.7 +/- 4.8 and 7.5 +/- 4.5 in those with AMI. Abnormal myocardial sympathetic nerve function scores on 123I-MIBG images were 14.8 +/- 4.0, 8.8 +/- 4.0 and 0.4 +/- 0.6 during the subacute, chronic, chronic II phases, respectively, in patients with Takotsubo cardiomyopathy, and 18.6 +/- 6.5, 16.8 +/- 6.8 and 12.9 +/- 5.2 in those with AMI. Myocardial 99mTc-PYP uptake was abnormal not only in patients with AMI but also in those with Takotsubo cardiomyopathy during the acute phase.
Takotsubo cardiomyopathy might represent a stunned myocardium caused by a disturbance of the coronary microcirculation.
我们使用二维超声心动图、99mTc-替曲膦、99mTc-焦磷酸钠、123I-苄基十五烷酸（BMIPP）和123I-间碘苄胍（MIBG）心肌单光子发射计算机断层显像（SPECT），对Takotsubo心肌病（短暂性左心室心尖气球样变）和急性心肌梗死（AMI）进行了比较。
我们在紧急入院时（急性期）、发作后2 - 14天（亚急性期）、1个月（慢性期）和3个月（慢性II期），对7例Takotsubo心肌病患者和7例AMI患者进行了检查。在超声心动图和SPECT图像上，将左心室分为9个区域，并根据从正常（0）到严重异常（4）的5个等级对每个区域的异常程度进行评分。
冠状动脉造影显示，Takotsubo心肌病患者无狭窄区域，而AMI患者有严重狭窄和/或闭塞性病变。Takotsubo心肌病患者心电图上ST段总抬高（mm）为7.8± 3.7，AMI患者为7.3±3.9。Takotsubo心肌病患者在急性期、亚急性期、慢性期和慢性II期超声心动图上的异常室壁运动评分分别为14.2±4.6、4.7±4.0、1.7±2.0和0.5±0.4，AMI患者分别为14.0±4.3、11.4±3.9、8.8±3.6和5.2±4.8。Takotsubo心肌病患者在急性期、亚急性期、慢性期和慢性II期99mTc-替曲膦图像上的异常心肌灌注评分分别为11.8±3.5、3.2±3.0、0.5±1.2和0.2±0.4，AMI患者分别为16.2±4.3、13.9±4.6、7.9±4.6和5.0±4.5。Takotsubo心肌病患者在亚急性期、慢性期和慢性II期123I-BMIPP图像上的异常心肌脂肪酸评分分别为12.6±3.7、6.8±3.2和0.4±0.6，AMI患者分别为16.5±5.1、14.7±4.8和7.5±4.5。Takotsubo心肌病患者在亚急性期、慢性期、慢性II期123I-MIBG图像上的异常心肌交感神经功能评分分别为14.8±4.0、8.8±4.0和0.4±0.6，AMI患者分别为18.6±6.5、16.8±6.8和12.9±5.2。心肌99mTc-焦磷酸钠摄取不仅在AMI患者急性期异常，在Takotsubo心肌病患者急性期也异常。
Takotsubo心肌病可能代表由冠状动脉微循环紊乱引起的心肌顿抑。
