Abnormal response to mental stress in patients with Takotsubo cardiomyopathy detected by gated single photon emission computed tomography

  • Roberto Sciagrà
  • Guido Parodi
  • Stefano Del Pace
  • Sabrina Genovese
  • Linda Zampini
  • Benedetta Bellandi
  • Gian Franco Gensini
  • Alberto Pupi
  • David Antoniucci
Original Article

Abstract

Purpose

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.

Methods

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.

Results

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 ± 0.20 vs 0.95 ± 0.11 (p < 0.05), −1.7 ± 6% vs 4 ± 5% (p < 0.02) and 2.5 (0, 4.25) vs 0 (0, 0) (p < 0.002), respectively.

Conclusion

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.

Keywords

Gated single photon emission computed tomography Mental stress Takotsubo cardiomyopathy 

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Roberto Sciagrà
    • 1
  • Guido Parodi
    • 2
  • Stefano Del Pace
    • 3
  • Sabrina Genovese
    • 1
  • Linda Zampini
    • 3
  • Benedetta Bellandi
    • 2
  • Gian Franco Gensini
    • 3
  • Alberto Pupi
    • 1
  • David Antoniucci
    • 2
  1. 1.Nuclear Medicine Unit, Department of Clinical PhysiopathologyUniversity of FlorenceFlorenceItaly
  2. 2.Division of CardiologyCareggi HospitalFlorenceItaly
  3. 3.Department of Heart and Vessels, Unit of General CardiologyCareggi HospitalFlorenceItaly

Personalised recommendations