Specific Manifestation of Single-Photon Emission Computed Tomography and Positron Emission Tomography Magnetic Resonance Imaging in a Man With Takotsubo Cardiomyopathy

摘要

Takotsubo cardiomyopathy (syndrome) is a relatively reversible clinical condition with transient microcirculatory dysfunction,1 but its pathophysiol-ogy is still elusive.2 In this imaging vignette, We present an acute takotsubo syndrome patient who had the metabolic assessment of myocardium by single-photon emission computed tomography and new positron emission tomography magnetic resonance imaging. This 75-year-old man with hypertension presented to the emergency department with sudden onset of left chest pain of 12-hour duration. Before presentation, he got pneumonia and received antibiotic treatment and recovered. An ECG showed ST-segment elevation in precordial leads (Figure 1). Emergency coronary angiography revealed 40% stenosis in proximal left anterior descending coronary artery but a complete absence of ruptured plaques or intracoronary thrombli by intravascular ultrasound examination. Left ventriculography (Movie I in the Data Supplement; Figure 2) and echocardiography (Movie II in the Data Supplement) revealed typical ballooning of the apical segments and hyperkinesis of the basal segments, with an ejection fraction of 48%. A diagnosis of takotsubo cardiomyopathy was made. Concomitantly, myocardial perfusion and glucose metabolism were assessed by means of technetium-99m methoxyisobutylisonitrile single-photon emission computed tomography and fluorine 18-fluorodeoxyglucose positron emission tomography magnetic resonance imaging. Single-photon emission computed tomography (Figure 3) indicated obvious perfusion defect in the akinetic left ventricular apex and para-apical regions. Fluorodeoxyglucose positron emission tomography magnetic resonance imaging (Movie III in the Data Supplement; Figures 4 and 5) showed severely reduced uptake of fluorine 18-fluorodeoxyglucose (indicative of disturbance of myocardial glucose uptake) and myocardial edema with dyskinesia in the apical region and left ventricular midsegments. Then the patient received medical therapy including an ACE (angiotensin-con-verting enzyme) inhibitor, a (3-blocker, and a statin and recovered. Four weeks after the attack, a repeat echocardiogram (Movie IV in the Data Supplement) showed notable improvement of cardiac wall motion and ejection fraction of 67%, confirming takotsubo event.