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Cardiac 99mTc sestamibi SPECT and 18F FDG PET as viability markers in takotsubo cardiomyopathy

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Abstract

In patients with heart failure (HF) due to coronary disease, a combined evaluation of perfusion and glucose metabolism by cardiac single photon emission computed tomography (SPECT)/positron emission tomography (PET) can be used to distinguish viable from non-viable myocardium, and current guidelines recommend cardiac SPECT and fluorodeoxyglucose (FDG) PET for viability assessment. Takotsubo cardiomyopathy (TTC) is a disease characterized by acute but reversible HF leaving no scarring. To explore how robust the semi-quantitative viability criteria used in cardiac SPECT and FDG PET stands their ground in a population with TTC. From 1 September 2009 to 1 October 2012, 24 patients suspected of TTC were enrolled in a multimodality cardiac imaging research project. Echocardiography, 99mTc SPECT, and 18F FDG PET were performed during the acute admission and at follow-up 4 months later. Nineteen patients had a final diagnosis of TTC consistent with Mayo Clinic Diagnostic Criteria. Three of these patients were excluded from further analysis, since wall motion abnormalities were not persistent at the time of nuclear imaging. The remaining sixteen patients exhibited a distinct pattern with HF, “apical ballooning” and a perfusion-metabolism defect in the midventricular/apical region. When viability criteria were applied, they identified significant scarring/limited hibernation in the akinetic part of the left ventricle. However, full recovery was found in all TTC patients on follow-up. Using the current guideline-endorsed viability criteria for semiquantitative cardiac SPECT and FDG PET, these modalities failed to demonstrate the presence of viability in the acute state of TTC.

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References

  1. Partington SL, Kwong RY, Dorbala S (2011) Multimodality imaging in the assessment of myocardial viability. Heart Fail Rev 16(4):381–395

    Article  PubMed  PubMed Central  Google Scholar 

  2. Schelbert HR (1994) Metabolic imaging to assess myocardial viability. J Nucl Med 35(4 Suppl):8S–14S

    PubMed  CAS  Google Scholar 

  3. Hendel RC, Berman DS, Di Carli MF, Heidenreich PA, Henkin RE, Pellikka PA, Pohost GM, Williams KA (2009) ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM 2009 appropriate use criteria for cardiac radionuclide imaging: a report of the American college of cardiology foundation appropriate use criteria task force, the American society of nuclear cardiology, the American college of radiology, the American heart association, the american society of echocardiography, the society of cardiovascular computed tomography, the society for cardiovascular magnetic resonance, and the society of nuclear medicine. J Am Coll Cardiol 53(23):2201–2229

    Article  PubMed  Google Scholar 

  4. McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Bohm M, Dickstein K, Falk V, Filippatos G, Fonseca C, Gomez-Sanchez MA, Jaarsma T, Kober L, Lip GY, Maggioni AP, Parkhomenko A, Pieske BM, Popescu BA, Ronnevik PK, Rutten FH, Schwitter J, Seferovic P, Stepinska J, Trindade PT, Voors AA, Zannad F, Zeiher A, Bax JJ, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, McDonagh T, Sechtem U, Bonet LA, Avraamides P, BenLamin HA, Brignole M, Coca A, Cowburn P, Dargie H, Elliott P, Flachskampf FA, Guida GF, Hardman S, Iung B, Merkely B, Mueller C, Nanas JN, Nielsen OW, Orn S, Parissis JT, Ponikowski P (2012) ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the task force for the diagnosis and treatment of acute and chronic heart failure 2012 of the European society of cardiology. Developed in collaboration with the heart failure association (HFA) of the ESC. Eur J Heart Fail 14(8):803–869

    Article  PubMed  CAS  Google Scholar 

  5. Hesse B, Tagil K, Cuocolo A, Anagnostopoulos C, Bardies M, Bax J, Bengel F, Busemann SE, Davies G, Dondi M, Edenbrandt L, Franken P, Kjaer A, Knuuti J, Lassmann M, Ljungberg M, Marcassa C, Marie PY, McKiddie F, O’Connor M, Prvulovich E, Underwood R, van Eck-Smit B (2005) EANM/ESC procedural guidelines for myocardial perfusion imaging in nuclear cardiology. Eur J Nucl Med Mol Imaging 32(7):855–897

    Article  PubMed  CAS  Google Scholar 

  6. Dilsizian V, Arrighi JA, Diodati JG, Quyyumi AA, Alavi K, Bacharach SL, Marin-Neto JA, Katsiyiannis PT, Bonow RO (1994) Myocardial viability in patients with chronic coronary artery disease. Comparison of 99 mTc-sestamibi with thallium reinjection and [18F]fluorodeoxyglucose. Circulation 89(2):578–587

    Article  PubMed  CAS  Google Scholar 

  7. Udelson JE, Coleman PS, Metherall J, Pandian NG, Gomez AR, Griffith JL, Shea NL, Oates E, Konstam MA (1994) Predicting recovery of severe regional ventricular dysfunction. Comparison of resting scintigraphy with 201Tl and 99mTc-sestamibi. Circulation 89(6):2552–2561

    Article  PubMed  CAS  Google Scholar 

  8. Kauffman GJ, Boyne TS, Watson DD, Smith WH, Beller GA (1996) Comparison of rest thallium-201 imaging and rest technetium-99m sestamibi imaging for assessment of myocardial viability in patients with coronary artery disease and severe left ventricular dysfunction. J Am Coll Cardiol 27(7):1592–1597

    Article  PubMed  CAS  Google Scholar 

  9. Bonow RO, Maurer G, Lee KL, Holly TA, Binkley PF, Desvigne-Nickens P, Drozdz J, Farsky PS, Feldman AM, Doenst T, Michler RE, Berman DS, Nicolau JC, Pellikka PA, Wrobel K, Alotti N, Asch FM, Favaloro LE, She L, Velazquez EJ, Jones RH, Panza JA (2011) Myocardial viability and survival in ischemic left ventricular dysfunction. N Engl J Med 364(17):1617–1625

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  10. Baer FM, Voth E, Deutsch HJ, Schneider CA, Horst M, de Vivie ER, Schicha H, Erdmann E, Sechtem U (1996) Predictive value of low dose dobutamine transesophageal echocardiography and fluorine-18 fluorodeoxyglucose positron emission tomography for recovery of regional left ventricular function after successful revascularization. J Am Coll Cardiol 28(1):60–69

    Article  PubMed  CAS  Google Scholar 

  11. Dote K, Sato H, Tateishi H, Uchida T, Ishihara M (1991) Myocardial stunning due to simultaneous multivessel coronary spasms: a review of 5 cases. J Cardiol 21(2):203–214

    PubMed  CAS  Google Scholar 

  12. Gianni M, Dentali F, Grandi AM, Sumner G, Hiralal R, Lonn E (2006) Apical ballooning syndrome or takotsubo cardiomyopathy: a systematic review. Eur Heart J 27(13):1523–1529

    Article  PubMed  Google Scholar 

  13. Madhavan M, Prasad A (2010) Proposed mayo clinic criteria for the diagnosis of tako-tsubo cardiomyopathy and long-term prognosis. Herz 35(4):240–243

    Article  PubMed  CAS  Google Scholar 

  14. Ako J, Sudhir K, Farouque HM, Honda Y, Fitzgerald PJ (2006) Transient left ventricular dysfunction under severe stress: brain-heart relationship revisited. Am J Med 119(1):10–17

    Article  PubMed  Google Scholar 

  15. Hurst RT, Prasad A, Askew JW III, Sengupta PP, Tajik AJ (2010) Takotsubo cardiomyopathy: a unique cardiomyopathy with variable ventricular morphology. JACC Cardiovasc Imaging 3(6):641–649

    Article  PubMed  Google Scholar 

  16. Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H, Gutgesell H, Reichek N, Sahn D, Schnittger I (1989) Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American society of echocardiography committee on standards, subcommittee on quantitation of two-dimensional echocardiograms. J Am Soc Echocardiogr 2(5):358–367

    Article  PubMed  CAS  Google Scholar 

  17. Lavine SJ, Salacata A (2003) Visual quantitative estimation: semiquantitative wall motion scoring and determination of ejection fraction. Echocardiography 20(5):401–410

    Article  PubMed  Google Scholar 

  18. Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, Pennell DJ, Rumberger JA, Ryan T, Verani MS (2002) Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the cardiac imaging committee of the council on clinical cardiology of the American heart association. Int J Cardiovasc Imaging 18(1):539–542

    PubMed  Google Scholar 

  19. Germano G, Kavanagh PB, Waechter P, Areeda J, Van KS, Sharir T, Lewin HC, Berman DS (2000) A new algorithm for the quantitation of myocardial perfusion SPECT. I: technical principles and reproducibility. J Nucl Med 41(4):712–719

    PubMed  CAS  Google Scholar 

  20. Beanlands RS, Ruddy TD, Dekemp RA, Iwanochko RM, Coates G, Freeman M, Nahmias C, Hendry P, Burns RJ, Lamy A, Mickleborough L, Kostuk W, Fallen E, Nichol G (2002) Positron emission tomography and recovery following revascularization (PARR-1): the importance of scar and the development of a prediction rule for the degree of recovery of left ventricular function. J Am Coll Cardiol 40(10):1735–1743

    Article  PubMed  Google Scholar 

  21. Akhter N, Nakajima K, Okuda K, Matsuo S, Yoneyama T, Taki J, Kinuya S (2008) Regional wall thickening in gated myocardial perfusion SPECT in a Japanese population: effect of sex, radiotracer, rotation angles and frame rates. Eur J Nucl Med Mol Imaging 35(9):1608–1615

    Article  PubMed  Google Scholar 

  22. Mohar DS, Kim JK, Patel PM (2012) Unique morphological variations of transient midventricular syndrome: a case series-review. Echocardiography 29(9):1132–1138

    Article  PubMed  Google Scholar 

  23. Morel O, Sauer F, Imperiale A, Cimarelli S, Blondet C, Jesel L, Trinh A, De PF, Ohlmann P, Constantinesco A, Bareiss P (2009) Importance of inflammation and neurohumoral activation in Takotsubo cardiomyopathy. J Card Fail 15(3):206–213

    Article  PubMed  CAS  Google Scholar 

  24. Rendl G, Rettenbacher L, Keinrath P, Altenberger J, Schuler J, Heigert M, Pichler M, Pirich C (2010) Different pattern of regional metabolic abnormalities in Takotsubo cardiomyopathy as evidenced by F-18 FDG PET-CT. Wien Klin Wochenschr 122(5–6):184–185

    Article  PubMed  CAS  Google Scholar 

  25. Cimarelli S, Sauer F, Morel O, Ohlmann P, Constantinesco A, Imperiale A (2010) Transient left ventricular dysfunction syndrome: patho-physiological bases through nuclear medicine imaging. Int J Cardiol 144(2):212–218

    Article  PubMed  Google Scholar 

  26. Feola M, Chauvie S, Rosso GL, Biggi A, Ribichini F, Bobbio M (2008) Reversible impairment of coronary flow reserve in takotsubo cardiomyopathy: a myocardial PET study. J Nucl Cardiol 15(6):811–817

    Article  PubMed  Google Scholar 

  27. Kurowski V, Kaiser A, Von HK, Killermann DP, Mayer B, Hartmann F, Schunkert H, Radke PW (2007) Apical and midventricular transient left ventricular dysfunction syndrome (tako-tsubo cardiomyopathy): frequency, mechanisms, and prognosis. Chest 132(3):809–816

    Article  PubMed  Google Scholar 

  28. Yoshida T, Hibino T, Kako N, Murai S, Oguri M, Kato K, Yajima K, Ohte N, Yokoi K, Kimura G (2007) A pathophysiologic study of tako-tsubo cardiomyopathy with F-18 fluorodeoxyglucose positron emission tomography. Eur Heart J 28(21):2598–2604

    Article  PubMed  CAS  Google Scholar 

  29. Yamashita K, Tamaki N, Yonekura Y, Ohtani H, Saji H, Mukai T, Kambara H, Kawai C, Ban T, Konishi J (1989) Quantitative analysis of regional wall motion by gated myocardial positron emission tomography: validation and comparison with left ventriculography. J Nucl Med 30(11):1775–1786

    PubMed  CAS  Google Scholar 

  30. Nowak B, Stellbrink C, Schaefer WM, Sinha AM, Breithardt OA, Kaiser HJ, Reinartz P, Hanrath P, Buell U (2004) Comparison of regional myocardial blood flow and perfusion in dilated cardiomyopathy and left bundle branch block: role of wall thickening. J Nucl Med 45(3):414–418

    PubMed  Google Scholar 

  31. Christensen TE, Ahtarovski KA, Andersson H, Vejlstrup N, Ihlemann N, Kjaer A, Holmvang L, Bang L, Grande P, Hasbak P (2012) Takotsubo-cardiomyopathy: A case of extremely fast recovery described by multimodality cardiac imaging. J Nucl Cardiol 19(6):1240–1242.

  32. Hasbak P, Kjaer A, Skovgaard D, Bang LE, Grande P, Holmvang L (2012) Preserved myocardial blood flow in the apical region involved in takotsubo cardiomyopathy by quantitative cardiac PET assessment. J Nucl Cardiol 19(1):169–171

    Article  PubMed  Google Scholar 

  33. Fischer Y, Thomas J, Sevilla L, Munoz P, Becker C, Holman G, Kozka IJ, Palacin M, Testar X, Kammermeier H, Zorzano A (1997) Insulin-induced recruitment of glucose transporter 4 (GLUT4) and GLUT1 in isolated rat cardiac myocytes. Evidence of the existence of different intracellular GLUT4 vesicle populations. J Biol Chem 272(11):7085–7092

    Article  PubMed  CAS  Google Scholar 

  34. Luiken JJ, Coort SL, Koonen DP, van der Horst DJ, Bonen A, Zorzano A, Glatz JF (2004) Regulation of cardiac long-chain fatty acid and glucose uptake by translocation of substrate transporters. Pflugers Arch 448(1):1–15

    Article  PubMed  CAS  Google Scholar 

  35. Vanoverschelde JL, Wijns W, Depre C, Essamri B, Heyndrickx GR, Borgers M, Bol A, Melin JA (1993) Mechanisms of chronic regional postischemic dysfunction in humans. New insights from the study of noninfarcted collateral-dependent myocardium. Circulation 87(5):1513–1523

    Article  PubMed  CAS  Google Scholar 

  36. Lyon AR, Rees PS, Prasad S, Poole-Wilson PA, Harding SE (2008) Stress (Takotsubo) cardiomyopathy–a novel pathophysiological hypothesis to explain catecholamine-induced acute myocardial stunning. Nat Clin Pract Cardiovasc Med 5(1):22–29

    Article  PubMed  CAS  Google Scholar 

  37. Takizawa M, Kobayakawa N, Uozumi H, Yonemura S, Kodama T, Fukusima K, Takeuchi H, Kaneko Y, Kaneko T, Fujita K, Honma Y, Aoyagi T (2007) A case of transient left ventricular ballooning with pheochromocytoma, supporting pathogenetic role of catecholamines in stress-induced cardiomyopathy or takotsubo cardiomyopathy. Int J Cardiol 114(1):e15–e17

    Article  PubMed  Google Scholar 

  38. Sanchez-Recalde A, Costero O, Oliver JM, Iborra C, Ruiz E, Sobrino JA (2006) Images in cardiovascular medicine. Pheochromocytoma-related cardiomyopathy: inverted Takotsubo contractile pattern. Circulation 113(17):e738–e739

    Article  PubMed  Google Scholar 

  39. Ellison GM, Torella D, Karakikes I, Purushothaman S, Curcio A, Gasparri C, Indolfi C, Cable NT, Goldspink DF, Nadal-Ginard B (2007) Acute beta-adrenergic overload produces myocyte damage through calcium leakage from the ryanodine receptor 2 but spares cardiac stem cells. J Biol Chem 282(15):11397–11409

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  40. Ling S, Komesaroff P, Sudhir K (2006) Cellular mechanisms underlying the cardiovascular actions of oestrogens. Clin Sci (Lond) 111(2):107–118

    Article  CAS  Google Scholar 

  41. Patten RD, Pourati I, Aronovitz MJ, Baur J, Celestin F, Chen X, Michael A, Haq S, Nuedling S, Grohe C, Force T, Mendelsohn ME, Karas RH (2004) 17beta-estradiol reduces cardiomyocyte apoptosis in vivo and in vitro via activation of phospho-inositide-3 kinase/Akt signaling. Circ Res 95(7):692–699

    Article  PubMed  CAS  Google Scholar 

  42. Kim RJ, Fieno DS, Parrish TB, Harris K, Chen EL, Simonetti O, Bundy J, Finn JP, Klocke FJ, Judd RM (1999) Relationship of MRI delayed contrast enhancement to irreversible injury, infarct age, and contractile function. Circulation 100(19):1992–2002

    Article  PubMed  CAS  Google Scholar 

  43. Inoue M, Shimizu M, Ino H, Yamaguchi M, Terai H, Fujino N, Sakata K, Funada A, Tatami R, Ishise S, Kanaya H, Mabuchi H (2005) Differentiation between patients with takotsubo cardiomyopathy and those with anterior acute myocardial infarction. Circ J 69(1):89–94

    Article  PubMed  Google Scholar 

  44. Kosuge M, Ebina T, Hibi K, Morita S, Okuda J, Iwahashi N, Tsukahara K, Nakachi T, Kiyokuni M, Ishikawa T, Umemura S, Kimura K (2010) Simple and accurate electrocardiographic criteria to differentiate takotsubo cardiomyopathy from anterior acute myocardial infarction. J Am Coll Cardiol 55(22):2514–2516

    Article  PubMed  Google Scholar 

  45. Jaguszewski M, Osipova J, Ghadri JR, Napp LC, Widera C, Franke J, Fijalkowski M, Nowak R, Fijalkowska M, Volkmann I, Katus HA, Wollert KC, Bauersachs J, Erne P, Luscher TF, Thum T, Templin C (2013) A signature of circulating microRNAs differentiates takotsubo cardiomyopathy from acute myocardial infarction. Eur Heart J 35(15):999–1006

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Authors and Affiliations

  1. Department of Clinical Physiology, Nuclear Medicine & PET, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen E, Denmark

    Thomas Emil Christensen, Adam Ali Ghotbi, Martin Lyngby Lassen, Flemming Andersen, Andreas Kjaer & Philip Hasbak

  2. Department of Cardiology, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen E, Denmark

    Thomas Emil Christensen, Lia Evi Bang, Lene Holmvang, Adam Ali Ghotbi, Nikolaj Ihlemann, Hedvig Andersson & Peer Grande

  3. Cluster for Molecular Imaging, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen N, 2200, Denmark

    Andreas Kjaer

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  1. Thomas Emil Christensen
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Christensen, T.E., Bang, L.E., Holmvang, L. et al. Cardiac 99mTc sestamibi SPECT and 18F FDG PET as viability markers in takotsubo cardiomyopathy. Int J Cardiovasc Imaging 30, 1407–1416 (2014). https://doi.org/10.1007/s10554-014-0453-5

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