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Yoshihiro J Akashi - One of the best experts on this subject based on the ideXlab platform.
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Takotsubo Cardiomyopathy associated with rupture of the left ventricular apex assessment of histopathological features of a fatal case and literature review
Forensic Science Medicine and Pathology, 2015Co-Authors: Francesca Indorato, Yoshihiro J Akashi, Carlo Rossitto, Cataldo Raffino, Giovanni BartoloniAbstract:Takotsubo Cardiomyopathy, also known as “broken heart syndrome,” is a cardiac entity characterized by transient left ventricular dysfunction without obstructive atherosclerotic coronary artery disease. An episode of emotional stress is believed to act as a trigger in the development of this syndrome, which typically occurs in female patients. We report a fatal case of a previously healthy 70-year-old woman who suffered an out-of-hospital cardiac arrest and cardiac rupture during emotional distress, due to Takotsubo Cardiomyopathy. Ventricular rupture with Takotsubo Cardiomyopathy is rare, but our case emphasizes the importance of dealing with this serious and potentially life-threatening disease. Takotsubo Cardiomyopathy should be considered as a differential diagnosis in cases of early-developing heart failure, and clinicians should subsequently use adequate diagnostic and therapeutic options.
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Takotsubo Cardiomyopathy the current state of knowledge
International Journal of Cardiology, 2010Co-Authors: Agata Bieleckadabrowa, Yoshihiro J Akashi, Dimitri P Mikhailidis, Simon Hannam, Jacek Rysz, Marta Michalska, Maciej BanachAbstract:Takotsubo Cardiomyopathy is defined as acute chest pain during stressful incidents which is associated with ST-segment abnormalities and/or increased serum troponin levels. There is also regressive systolic dysfunction which is usually localized in the apical and medial left ventricles but there are no significant coronary artery lesions. The ventricular asynergy is also described in the right ventricle but is less common. Almost all the patients are women. The onset of this disease is typically triggered by an acute emotional or stress event or by an accumulation of trivial and repetitive stresses. The etiology of this syndrome remains unclear. Myocardial ischemia and reperfusion due to microvascular spasm, aborted myocardial infarction and related no-reflow phenomenon have been proposed as inducers of Takotsubo Cardiomyopathy. The temporal relationship between the stressful event and the triggering of the clinical syndrome as well as the report of elevated catecholamine plasma levels during the acute phase suggest a possible involvement of the sympathetic nervous system. A smaller left ventricular size and hormonal disturbances in women may also play a role.
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mechanisms of stress Takotsubo Cardiomyopathy
Nature Reviews Cardiology, 2010Co-Authors: Holger Nef, Yoshihiro J Akashi, Helge Mollmann, Christian W HammAbstract:Stress Cardiomyopathy, also referred to as Takotsubo Cardiomyopathy, transient apical ballooning or broken heart syndrome, is a disorder associated with transient left ventricular dysfunction. Symptoms include acute chest pain and dyspnea accompanied by electrocardiographic changes, such as ST-segment elevation and T-wave inversions, minimal elevation of cardiac enzyme levels and transient wall-motion abnormalities in the absence of substantial coronary artery obstruction. Complete recovery of contractile function has been documented in nearly all cases, but the mechanisms of disease remain unclear and the cause has not been established. Coronary artery vasospasm, microcirculation dysfunction, and transient obstruction of the left ventricular outflow tract have been proposed as possible causes of this disorder. An excessive release of catecholamines also seems to have a pivotal role in the development of stress Cardiomyopathy. This Review summarizes published data on stress Cardiomyopathy, focusing primarily on the most likely causes of this cardiac entity.
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Takotsubo Cardiomyopathy a new form of acute reversible heart failure
Circulation, 2008Co-Authors: Yoshihiro J Akashi, David S Goldstein, Giuseppe Barbaro, Takashi UeyamaAbstract:Several relatively recent case reports and series have described a condition featuring symptoms and signs of acute myocardial infarction without demonstrable coronary artery stenosis or spasm in which the heart takes on the appearance of a Japanese octopus fishing pot called a Takotsubo (Figure 1). In Takotsubo Cardiomyopathy (also called transient apical ballooning and stress Cardiomyopathy), left ventricular dysfunction, which can be remarkably depressed, recovers within a few weeks.1–4 Figure 1 Left ventriculogram (A, end-diastolic phase; B, end-systolic phase) in the right anterior oblique projection. The extensive area around the apex shows akinesis, and the basal segments display hypercontraction, especially in the end-diastolic phase. C, ... Takotsubo Cardiomyopathy occurs predominantly in post-menopausal women soon after exposure to sudden, unexpected emotional or physical stress. For instance, the incidence of Takotsubo Cardiomyopathy increased substantially in elderly women living near the epicenter of the Niigata earthquake.4 Although the left ventricular dysfunction is transient and there is no evidence of obstructive epicardial coronary disease, an increasing number of angioplasty procedures have been performed for presumed acute coronary syndromes. Concepts about the demographics, clinical features, prognosis, and management of this reversible form of left ventricular failure are still evolving. In this brief review, we summarize recent clinical reports and discuss an animal model that may clarify the pathogenesis of this condition.
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reversible ventricular dysfunction Takotsubo Cardiomyopathy
European Journal of Heart Failure, 2005Co-Authors: Yoshihiro J Akashi, Haruki Musha, Kensuke Kawasaki, Nobuyuki Hashimoto, Keisuke Kida, Kae Itoh, Koji Inoue, Fumihiko MiyakeAbstract:Background: Recently, many cardiologists have recognized the existence of a rapidly reversible form of heart failure of unknown origin characterized by a Takotsubo-shaped, dyskinetic left ventricle on left ventriculography. Aim: To determine the detailed clinical features of Takotsubo Cardiomyopathy. Methods: Thirteen elderly patients (11 women and 2 men with a mean age of 75.3 years) who had normal coronary arteries and Takotsubo-like left ventricular dysfunction were prospectively enrolled in this study. Results: Cardiac enzymes did not increase significantly, but the mean plasma norepinephrine level was very high on admission (0.98 μg/l). Coronary angiography revealed normal coronary arteries in all patients, but left ventriculography showed apical akinesis combined with basal hyperkinesis, i.e., a Takotsubo (Japanese octopus fishing pot)-shaped ventricle. Left ventricular wall motion normalized within a mean of 16.9 hospital days in 12 patients, but 1 patient died of acute renal failure on hospital day 7. Cardiac events did not recur during a follow-up period of 0.5 to 5 years. Conclusion: Takotsubo Cardiomyopathy seems to be a new type of acute heart failure, which generally has a good prognosis and does not recur. Myocardial damage by catecholamine overload, adrenoceptor hypersensitivity, and changes of catecholamine dynamics due to stress may cause this condition.
Haruki Musha - One of the best experts on this subject based on the ideXlab platform.
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reversible ventricular dysfunction Takotsubo Cardiomyopathy
European Journal of Heart Failure, 2005Co-Authors: Yoshihiro J Akashi, Haruki Musha, Kensuke Kawasaki, Nobuyuki Hashimoto, Keisuke Kida, Kae Itoh, Koji Inoue, Fumihiko MiyakeAbstract:Background: Recently, many cardiologists have recognized the existence of a rapidly reversible form of heart failure of unknown origin characterized by a Takotsubo-shaped, dyskinetic left ventricle on left ventriculography. Aim: To determine the detailed clinical features of Takotsubo Cardiomyopathy. Methods: Thirteen elderly patients (11 women and 2 men with a mean age of 75.3 years) who had normal coronary arteries and Takotsubo-like left ventricular dysfunction were prospectively enrolled in this study. Results: Cardiac enzymes did not increase significantly, but the mean plasma norepinephrine level was very high on admission (0.98 μg/l). Coronary angiography revealed normal coronary arteries in all patients, but left ventriculography showed apical akinesis combined with basal hyperkinesis, i.e., a Takotsubo (Japanese octopus fishing pot)-shaped ventricle. Left ventricular wall motion normalized within a mean of 16.9 hospital days in 12 patients, but 1 patient died of acute renal failure on hospital day 7. Cardiac events did not recur during a follow-up period of 0.5 to 5 years. Conclusion: Takotsubo Cardiomyopathy seems to be a new type of acute heart failure, which generally has a good prognosis and does not recur. Myocardial damage by catecholamine overload, adrenoceptor hypersensitivity, and changes of catecholamine dynamics due to stress may cause this condition.
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plasma brain natriuretic peptide in Takotsubo Cardiomyopathy
QJM: An International Journal of Medicine, 2004Co-Authors: Yoshihiro J Akashi, Haruki Musha, Kiyoshi Nakazawa, Fumihiko MiyakeAbstract:Background: Takotsubo Cardiomyopathy is a reversible left ventricular dysfunction with symptoms resembling acute myocardial infarction, but without coronary lesions. Patients have wall motion abnormalities (apical akinesis and basal hyperkinesis), and characteristic left ventricular morphology. Aim: To investigate plasma brain natriuretic peptide (BNP) concentrations in Takotsubo Cardiomyopathy. Methods: Ten consecutive patients with Takotsubo Cardiomyopathy underwent cardiac catheterization on their first hospital day, and blood was collected to measure BNP. To evaluate acute basal hyperkinesis, the difference in diameter between systole and diastole was measured at 10 mm below the aortic valve (the δBase value). Results: Coronary angiography revealed no significant stenosis in any patient. Initial ejection fraction was 42.2 ± 7.3%, cardiac index was 1.90 ± 0.39 l/min/m2, and plasma BNP was 522.5 ± 632.9 pg/ml. Ventricular contraction and the ejection fraction were normalized on echocardiography after 17.9 ± 6.3 days. BNP was significantly correlated with δBase, but not with other cardiac parameters. Discussion: Initial δBase value seems to be a good indicator of the severity of basal hyperkinesis in patients with Takotsubo Cardiomyopathy. In contrast to other diagnoses, a high BNP concentration is not associated with a poor prognosis in this condition.
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123i mibg myocardial scintigraphy in patients with Takotsubo Cardiomyopathy
The Journal of Nuclear Medicine, 2004Co-Authors: Yoshihiro J Akashi, Haruki Musha, Kiyoshi Nakazawa, Fumihiko Miyake, Masayoshi Sakakibara, Kaoru SasakaAbstract: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.
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123i mibg myocardial scintigraphy in patients with Takotsubo Cardiomyopathy
The Journal of Nuclear Medicine, 2004Co-Authors: Yoshihiro J Akashi, Haruki Musha, Kiyoshi Nakazawa, Fumihiko Miyake, Masayoshi Sakakibara, Kaoru SasakaAbstract: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 123I-metaiodobenzlguanidine (123I-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. 123I-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
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left ventricular rupture associated with Takotsubo Cardiomyopathy
Mayo Clinic Proceedings, 2004Co-Authors: Yoshihiro J Akashi, Tamotsu Tejima, Harumizu Sakurada, Hisao Matsuda, Kengo Suzuki, Kensuke Kawasaki, Katsuhiko Tsuchiya, Nobuyuki Hashimoto, Haruki MushaAbstract:A 70-year-old woman was admitted to the hospital with chest discomfort after quarreling with her neighbors. Electrocardiography revealed ST-segment elevation in leads I, II, III, aVL, aVF, and V2 through V6. Coronary angiography demonstrated normal arteries, but left ventriculography showed apical akinesis and basal hyperkinesis. Takotsubo Cardiomyopathy was diagnosed on the basis of these characteristic findings. The creatine kinase and creatine kinase-MB concentrations were elevated at admission and reached maximum levels 6 hours after admission. The plasma level of brain natriuretic peptide was 10.7 pg/mL (reference range, <18.4 pg/mL) on the first hospital day. ST-segment elevation in leads I, II, III, aVL, aVF, and V2 through V6 persisted at 72 hours after admission. On the third hospital day, sudden rupture of the left ventricle occurred, and despite extensive resuscitation efforts, the patient died. Takotsubo Cardiomyopathy presents in a manner similar to that of acute myocardial infarction, but ventricular systolic function usually returns to normal within a few weeks. To our knowledge, this is the first reported case of fatal left ventricular rupture associated with Takotsubo Cardiomyopathy. We suggest that Takotsubo Cardiomyopathy may be a newly recognized cause of sudden cardiac death.
Fumihiko Miyake - One of the best experts on this subject based on the ideXlab platform.
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reversible ventricular dysfunction Takotsubo Cardiomyopathy
European Journal of Heart Failure, 2005Co-Authors: Yoshihiro J Akashi, Haruki Musha, Kensuke Kawasaki, Nobuyuki Hashimoto, Keisuke Kida, Kae Itoh, Koji Inoue, Fumihiko MiyakeAbstract:Background: Recently, many cardiologists have recognized the existence of a rapidly reversible form of heart failure of unknown origin characterized by a Takotsubo-shaped, dyskinetic left ventricle on left ventriculography. Aim: To determine the detailed clinical features of Takotsubo Cardiomyopathy. Methods: Thirteen elderly patients (11 women and 2 men with a mean age of 75.3 years) who had normal coronary arteries and Takotsubo-like left ventricular dysfunction were prospectively enrolled in this study. Results: Cardiac enzymes did not increase significantly, but the mean plasma norepinephrine level was very high on admission (0.98 μg/l). Coronary angiography revealed normal coronary arteries in all patients, but left ventriculography showed apical akinesis combined with basal hyperkinesis, i.e., a Takotsubo (Japanese octopus fishing pot)-shaped ventricle. Left ventricular wall motion normalized within a mean of 16.9 hospital days in 12 patients, but 1 patient died of acute renal failure on hospital day 7. Cardiac events did not recur during a follow-up period of 0.5 to 5 years. Conclusion: Takotsubo Cardiomyopathy seems to be a new type of acute heart failure, which generally has a good prognosis and does not recur. Myocardial damage by catecholamine overload, adrenoceptor hypersensitivity, and changes of catecholamine dynamics due to stress may cause this condition.
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plasma brain natriuretic peptide in Takotsubo Cardiomyopathy
QJM: An International Journal of Medicine, 2004Co-Authors: Yoshihiro J Akashi, Haruki Musha, Kiyoshi Nakazawa, Fumihiko MiyakeAbstract:Background: Takotsubo Cardiomyopathy is a reversible left ventricular dysfunction with symptoms resembling acute myocardial infarction, but without coronary lesions. Patients have wall motion abnormalities (apical akinesis and basal hyperkinesis), and characteristic left ventricular morphology. Aim: To investigate plasma brain natriuretic peptide (BNP) concentrations in Takotsubo Cardiomyopathy. Methods: Ten consecutive patients with Takotsubo Cardiomyopathy underwent cardiac catheterization on their first hospital day, and blood was collected to measure BNP. To evaluate acute basal hyperkinesis, the difference in diameter between systole and diastole was measured at 10 mm below the aortic valve (the δBase value). Results: Coronary angiography revealed no significant stenosis in any patient. Initial ejection fraction was 42.2 ± 7.3%, cardiac index was 1.90 ± 0.39 l/min/m2, and plasma BNP was 522.5 ± 632.9 pg/ml. Ventricular contraction and the ejection fraction were normalized on echocardiography after 17.9 ± 6.3 days. BNP was significantly correlated with δBase, but not with other cardiac parameters. Discussion: Initial δBase value seems to be a good indicator of the severity of basal hyperkinesis in patients with Takotsubo Cardiomyopathy. In contrast to other diagnoses, a high BNP concentration is not associated with a poor prognosis in this condition.
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123i mibg myocardial scintigraphy in patients with Takotsubo Cardiomyopathy
The Journal of Nuclear Medicine, 2004Co-Authors: Yoshihiro J Akashi, Haruki Musha, Kiyoshi Nakazawa, Fumihiko Miyake, Masayoshi Sakakibara, Kaoru SasakaAbstract: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.
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123i mibg myocardial scintigraphy in patients with Takotsubo Cardiomyopathy
The Journal of Nuclear Medicine, 2004Co-Authors: Yoshihiro J Akashi, Haruki Musha, Kiyoshi Nakazawa, Fumihiko Miyake, Masayoshi Sakakibara, Kaoru SasakaAbstract: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 123I-metaiodobenzlguanidine (123I-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. 123I-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
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123I-MIBG myocardial scintigraphy in patients with ‘‘Takotsubo’’ Cardiomyopathy
2004Co-Authors: Yoshihiro J Akashi, Kiyoshi Nakazawa, Fumihiko Miyake, Md Masayoshi Sakakibara, Md Haruki Musha, Kaoru SasakaAbstract:The clinical characteristics of reversible left ventricular dysfunc-tion due to “Takotsubo ” Cardiomyopathy have been described, but the origin of this condition remains unclear. This study investigated 123I-metaiodobenzlguanidine (123I-MIBG) myocar-dial scintigraphy in patients with Takotsubo Cardiomyopathy. Methods: Eight consecutive patients with Takotsubo cardiomy-opathy were studied. Left ventricular wall motion was monitored by echocardiography until wall motion normalized. 123I-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 123I-MIBG myocardial scintig-raphy 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. Key Words: “Takotsubo ” Cardiomyopathy; reversible ventricular dysfunction; 123I-metaiodobenzlguanidine; stunned myocar
Kaoru Sasaka - One of the best experts on this subject based on the ideXlab platform.
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123i mibg myocardial scintigraphy in patients with Takotsubo Cardiomyopathy
The Journal of Nuclear Medicine, 2004Co-Authors: Yoshihiro J Akashi, Haruki Musha, Kiyoshi Nakazawa, Fumihiko Miyake, Masayoshi Sakakibara, Kaoru SasakaAbstract: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.
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123i mibg myocardial scintigraphy in patients with Takotsubo Cardiomyopathy
The Journal of Nuclear Medicine, 2004Co-Authors: Yoshihiro J Akashi, Haruki Musha, Kiyoshi Nakazawa, Fumihiko Miyake, Masayoshi Sakakibara, Kaoru SasakaAbstract: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 123I-metaiodobenzlguanidine (123I-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. 123I-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
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123I-MIBG myocardial scintigraphy in patients with ‘‘Takotsubo’’ Cardiomyopathy
2004Co-Authors: Yoshihiro J Akashi, Kiyoshi Nakazawa, Fumihiko Miyake, Md Masayoshi Sakakibara, Md Haruki Musha, Kaoru SasakaAbstract:The clinical characteristics of reversible left ventricular dysfunc-tion due to “Takotsubo ” Cardiomyopathy have been described, but the origin of this condition remains unclear. This study investigated 123I-metaiodobenzlguanidine (123I-MIBG) myocar-dial scintigraphy in patients with Takotsubo Cardiomyopathy. Methods: Eight consecutive patients with Takotsubo cardiomy-opathy were studied. Left ventricular wall motion was monitored by echocardiography until wall motion normalized. 123I-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 123I-MIBG myocardial scintig-raphy 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. Key Words: “Takotsubo ” Cardiomyopathy; reversible ventricular dysfunction; 123I-metaiodobenzlguanidine; stunned myocar
B J B Hamer - One of the best experts on this subject based on the ideXlab platform.
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Takotsubo Cardiomyopathy following radioiodine therapy for toxic multinodular goitre
Netherlands Journal of Medicine, 2009Co-Authors: N Van De Donk, Yves G. C. J. America, P M J Zelissen, B J B HamerAbstract:abstraCtwe report on a 73-year-old man with a toxic multinodular goitre, which was treated with radioiodine therapy (i-131) without pretreatment with an antithyroid drug. four weeks later he presented with rapidly progressive dyspnoea and a significant increase in free thyroxin. the electrocardiogram showed st-segment elevation, and echocardiography demonstrated apical akinesia and a left ventricular ejection fraction of only 25%. however, direct coronary catheterisation showed no evidence of coronary artery disease. left ventricular angiography showed apical ballooning consistent with the diagnosis of Takotsubo Cardiomyopathy. following treatment of the Cardiomyopathy and thyrotoxicosis, he experienced a complete recovery. to the best of our knowledge, this is the first report of a Takotsubo Cardiomyopathy associated with thyrotoxicosis resulting from radiation thyroiditis induced by radioiodine. three other cases of Takotsubo Cardiomyopathy associated with graves’ disease have been described in literature. KeywordsHeart failure, radioiodine therapy, Takotsubo Cardiomyopathy, toxic multinodular goitreintroduCtionTakotsubo Cardiomyopathy, also called stress-induced Cardiomyopathy, consists of reversible apical or midventricular left ventricular dysfunction with sparing of the basal segments, without significant epicardial coronary artery stenosis. This entity is named after the round-bottomed narrow-necked Japanese fishing pot used for trapping octopus, because of the peculiar left ventricle apical ballooning evident on left ventriculogram. It is typically triggered by an acute medical illness such as sepsis,
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Takotsubo Cardiomyopathy following radioiodine therapy for toxic multinodular goitre
The Netherlands journal of medicine, 2009Co-Authors: N. Van De Donk, Yves G. C. J. America, P M J Zelissen, B J B HamerAbstract:We report on a 73-year-old man with a toxic multinodular goitre, which was treated with radioiodine therapy (I-131) without pretreatment with an antithyroid drug. Four weeks later he presented with rapidly progressive dyspnoea and a significant increase in free thyroxin. The electrocardiogram showed ST -segment elevation, and echocardiography demonstrated apical akinesia and a left ventricular ejection fraction of only 25%. However, direct coronary catheterisation showed no evidence of coronary artery disease. Left ventricular angiography showed apical ballooning consistent with the diagnosis of Takotsubo Cardiomyopathy. Following treatment of the Cardiomyopathy and thyrotoxicosis, he experienced a complete recovery. To the best of our knowledge, this is the first report of a Takotsubo Cardiomyopathy associated with thyrotoxicosis resulting from radiation thyroiditis induced by radioiodine. Three other cases of Takotsubo Cardiomyopathy associated with Graves' disease have been described in literature.
