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In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Transient left ventricular dysfunction syndrome: patho-physiological bases through nuclear medicine imaging.
Sébastien Cimarelli1, Frédérique Sauer, Olivier Morel
1Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Strasbourg Cedex, France. cimarell@lyon.fnclcc.fr
International Journal of Cardiology
|May 16, 2009
Summary
Transient left ventricular dysfunction syndrome (TLVDS), also known as Takotsubo cardiomyopathy, involves neurogenic stunned myocardium. Nuclear imaging, particularly (123)I-mIBG SPECT, aids in diagnosing TLVDS by assessing sympathetic function and metabolism.
Area of Science:
- Cardiology
- Nuclear Medicine
- Cardiomyopathy Research
Background:
- Takotsubo cardiomyopathy (TTC) is a heart condition mimicking myocardial infarction.
- Transient left ventricular dysfunction syndrome (TLVDS) is a more encompassing term for TTC variants.
- The pathophysiology and management of TLVDS require further elucidation.
Purpose of the Study:
- To characterize the patho-physiological mechanisms of TLVDS using nuclear medicine.
- To evaluate the clinical utility of isotopic imaging for non-invasive TLVDS diagnosis.
Main Methods:
- 18 patients with TLVDS underwent Gated Single Photon Emission Computed Tomography (G-SPECT), (123)I-mIBG SPECT, and Gated Positron Emission Tomography (G-PET).
- Procedures assessed left ventricular (LV) perfusion, sympathetic innervation, and glucose metabolism.
- Follow-up imaging evaluated changes in LV motion, metabolism, and innervation.
Main Results:
- Hypocontractile LV segments showed normal perfusion but reduced (18)F-FDG and (123)I-mIBG uptake.
- Metabolic defects and innervation abnormalities largely overlapped in topography and extent.
- Follow-up revealed normalization of LV motion with improved glucose metabolism and sympathetic innervation.
Conclusions:
- Neurogenic stunned myocardium is hypothesized as the central mechanism of TLVDS.
- (123)I-mIBG SPECT is proposed as the most specific diagnostic technique for TLVDS.
- Nuclear imaging plays a crucial role in understanding TLVDS pathophysiology.
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