Transient left ventricular dysfunction syndrome: Patho-physiological bases through nuclear medicine imaging
Transient left ventricular dysfunction syndrome: Patho-physiological bases through nuclear medicine imaging
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DOI：
10.1016/j.ijcard.2009.04.025
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发表时间：
2010-10-08
影响因子：
3.5
通讯作者：
Imperiale, Alessio
中科院分区：
文献类型：
--
作者：
Cimarelli, Sebastien;Sauer, Frederique;Imperiale, Alessio
背景：Takotsubo心肌病（TTC）是一种类似急性心肌梗死的新型心脏病。术语“短暂性左心室功能障碍综合征”（TLVDS）似乎更合适，因为TTC保留根尖段的不同形式（中心室球囊综合征（MVBS）和倒置TTC）已经被描述过。TLVDS的病理生理基础尚不清楚，其最佳治疗至今仍是经验经验。我们的目的是通过核医学手段来描述TLVDS的病理生理机制，并讨论同位素成像对TLVDS非侵入性诊断的临床应用价值。方法和结果：在亚急性期，18例TLVDS患者（TTC 13例，MVBS 5例）行心肌tc -99m-四氟氰胺或（201）铊门控单光子发射计算机断层扫描（G-SPECT） （n=11）、I-123-mIBG断层扫描（n=8）和F-18-FDG门控正电子发射断层扫描（G-PET） （n= 15），分别评估左室灌注、交感神经支配和葡萄糖代谢。低收缩的左室节段表现为灌注正常，但F-18-FDG和I-123-mIBG摄取减少。代谢缺陷和神经支配异常的地形和范围在很大程度上重叠。随访的I-123-mIBG SPECT和F-18-FDG - G-PET显示左室运动迅速正常化，葡萄糖代谢和交感神经支配逐渐改善。讨论：假设神经源性休克心肌是TLVDS的主要致病机制，I-123-mIBG SPECT似乎是最特异的诊断技术。交感功能和葡萄糖代谢似乎在低收缩的左室节段密切相关。最后，我们的研究结果强调了核成像在TLVDS病理生理机制设置中的作用。2009爱思唯尔爱尔兰有限公司版权所有。
Background: Takotsubo cardiomyopathy (TTC) is a novel heart disease, mimicking acutemyocardial infarction. The term "transient left ventricular dysfunction syndrome" (TLVDS) seems to be more appropriate since variant forms of TTC sparing apical segments (mid-ventricular ballooning syndrome (MVBS) and inverted TTC) have been described. Patho-physiological bases of TLVDS remain poorly understood and its optimal management is until now empirical. Our aim was to characterize patho-physiological mechanisms of TLVDS by means of nuclear medicine procedures and to discuss the clinical usefulness of isotopic imaging for a non-invasive diagnosis of TLVDS.Methods and results: During the sub acute phase, eighteen patients with TLVDS (13 TTC and 5 MVBS) underwent myocardial Tc-99m-tetrofosmin or (201)Thallium Gated Single Photon Emission Computed Tomography (G-SPECT) (n=11), I-123-mIBG SPECT (n=8) and F-18-FDG Gated Positron Emission Tomography (G-PET) (n= 15), assessing respectively LV perfusion, sympathetic innervation and glucose metabolism. Hypocontractile LV segments were characterized by normal perfusion but reduced uptake of F-18-FDG and I-123-mIBG. Topography and extent of metabolic defects and innervation abnormalities were largely overlapping. Follow-up I-123-mIBG SPECT and F-18-FDG G-PET were performed in selected patients showing rapid normalization of LV motion and progressive improvement of both glucose metabolism and sympathetic innervation.Discussion: With the hypothesis of neurogenic stunned myocardium as the central causative mechanism of TLVDS, I-123-mIBG SPECT seems to be the most specific diagnostic technique. Sympathetic function and glucose metabolism seem to be strictly correlated in the hypocontractile LV segments. Finally, our results underline the role of nuclear imaging in the setting of patho-physiological mechanisms of TLVDS. (C) 2009 Elsevier Ireland Ltd. All rights reserved.