Nuclear Medicine Unit, Department of Clinical Physiopathology, University of Florence, Viale Morgagni 85, 50134 Florence, Italy.
Eur J Nucl Med Mol Imaging. 2010 Apr;37(4):765-72. doi: 10.1007/s00259-009-1362-z. Epub 2010 Jan 27.
Persistent abnormalities are usually not detected in patients with Takotsubo cardiomyopathy (TTC). Since sympathetically mediated myocardial damage has been proposed as a causative mechanism of TTC, we explored whether mental stress could evoke abnormalities in these patients.
One month after an acute event, 22 patients fulfilling all TTC diagnostic criteria and 11 controls underwent resting and mental stress gated single photon emission computed tomography (SPECT). Perfusion, wall motion, transient ischaemic dilation (TID) and left ventricular (LV) ejection fraction (EF) were evaluated.
None of the controls showed stress-induced abnormalities. Mental stress evoked regional changes (perfusion defects and/or wall motion abnormality) in 16 TTC subjects and global abnormalities (LVEF fall >5% and/or TID >1.10) in 13; 3 had a completely negative response. TID, delta LVEF and delta wall motion score were significantly different in TTC vs control patients: 1.08 + or - 0.20 vs 0.95 + or - 0.11 (p < 0.05), -1.7 + or - 6% vs 4 + or - 5% (p < 0.02) and 2.5 (0, 4.25) vs 0 (0, 0) (p < 0.002), respectively.
Mental stress may evoke regional and/or global abnormalities in most TTC patients. The abnormal response to mental stress supports the role of sympathetic stimulation in TTC. Mental stress could thus be helpful for TTC evaluation.
Takotsubo 心肌病（TTC）患者通常不会检测到持续性异常。由于交感神经过度介导的心肌损伤被认为是 TTC 的发病机制之一，因此我们探讨了精神应激是否会引起这些患者的异常。
在急性事件发生后 1 个月，22 例符合所有 TTC 诊断标准的患者和 11 例对照者接受了静息和精神应激门控单光子发射计算机断层扫描（SPECT）检查。评估灌注、室壁运动、短暂性缺血性扩张（TID）和左心室（LV）射血分数（EF）。
对照组中无人出现应激诱导的异常。精神应激在 16 例 TTC 患者中诱发了区域性改变（灌注缺损和/或室壁运动异常），在 13 例患者中诱发了全局异常（EF 下降>5%和/或 TID>1.10）；3 例患者完全无反应。TTC 与对照组患者的 TID、ΔLVEF 和Δ壁运动评分差异有统计学意义：1.08±0.20 比 0.95±0.11（p<0.05），-1.7±6% 比 4±5%（p<0.02）和 2.5（0，4.25）比 0（0，0）（p<0.002）。
精神应激可能会引起大多数 TTC 患者的区域性和/或全身性异常。对精神应激的异常反应支持交感神经刺激在 TTC 中的作用。因此，精神应激可能有助于 TTC 的评估。
