technetium-tc-99m-tetrofosmin and Cardiomyopathies

Early diagnosis and initiating treatment of cardiac sarcoidosis are essential because cardiac involvement is an important prognostic factor. Although there are many reports on the diagnosis of cardiac sarcoidosis, the literature on predicting the efficacy of steroid therapy is very limited. The purposes of this study were to investigate the myocardial washout of (99m)Tc-tetrofosmin (TF), and to evaluate the predictability of left ventricular (LV) functional recovery after steroid therapy in patients with cardiac sarcoidosis.. We performed TF-gated SPECT and echocardiography for ten patients with cardiac sarcoidosis before and after initiating steroid therapy. SPECT images were acquired at 30 min (early images) and 3 h (delayed images) after injection. We calculated the total defect score (TDS) and left ventricular ejection fraction (LVEF). The washout score (WOS) was considered as the difference between the early and delayed TDS. In addition, we defined DeltaLVEF as the change in LVEF after initiating steroid therapy. Furthermore, we analyzed the regional TF myocardial uptake (%uptake) and the regional LV function (wall thickness, WT) by the 20-segment model on polar maps as regional indices. The regional washout (RWO) was defined as the change in %uptake between the early and delayed images in TF SPECT before the therapy. We calculated the improvement factor of the regional LV function as DeltaWT (WT after initiating therapy - WT before the therapy) and investigated the relationships among the indices.. We observed WO in 6 of 10 patients (60%). Decreased WT on echocardiography was observed in only 2 of 6 patients (33.3%) in the WO(+) group and in all 4 patients (100%) in the WO(-) group (p < 0.05). WOS before initiating steroid therapy exhibited a good correlation with DeltaLVEF (r = 0.685, p < 0.05). In the regional analysis, %uptake in the early images and delayed images before therapy did not significantly correlate with DeltaWT. In contrast, RWO before therapy was well correlated with DeltaWT (r = 0.435, p < 0.05).. Our preliminary study shows that there is a relationship between washout of (99m)Tc-tetrofosmin and the LV functional recovery after steroid therapy in patients with cardiac sarcoidosis.

Topics: Cardiomyopathies; Echocardiography; Female; Heart; Humans; Male; Middle Aged; Myocardium; Organophosphorus Compounds; Organotechnetium Compounds; Recovery of Function; Sarcoidosis; Steroids; Tomography, Emission-Computed, Single-Photon; Treatment Outcome; Ventricular Dysfunction, Left

We compared Takotsubo cardiomyopathy (transient left ventricular apical ballooning) with acute myocardial infarction (AMI) using two-dimensional echocardiography, 99mTc-tetrofosmin, 99mTc-PYP, 123I-BMIPP and 123I-MIBG myocardial SPECT.. We examined 7 patients with Takotsubo cardiomyopathy and 7 with AMI at the time of emergency admission (acute phase), and 2-14 days (subacute phase), one month (chronic phase), and 3 months (chronic II phase) after the attack. The left ventricle was divided into nine regions on echocardiograms and SPECT images, and the degree of abnormalities in each region was scored according to five grades from normal (0) to severely abnormal (4).. Coronary angiography showed the absence of stenotic regions in patients with Takotsubo cardiomyopathy, and severely stenotic and/or occlusive lesions in patients with AMI. The total ST segment elevation on electrocardiograms (mm) was 7.8 +/- 3.7 in those with Takotsubo cardiomyopathy, and 7.3 +/- 3.9 in patients with AMI. Abnormal wall motion scores on echocardiograms were 14.2 +/- 4.6, 4.7 +/- 4.0, 1.7 +/- 2.0 and 0.5 +/- 0.4 during the acute, subacute, chronic and chronic II phases, respectively, in patients with Takotsubo cardiomyopathy, and 14.0 +/- 4.3, 11.4 +/- 3.9, 8.8 +/- 3.6 and 5.2 +/- 4.8 in those with AMI. Abnormal myocardial perfusion scores on 99mTc-tetrofosmin images were 11.8 +/- 3.5, 3.2 +/- 3.0, 0.5 +/- 1.2 and 0.2 +/- 0.4 during the acute, subacute, chronic and chronic II phases, in patients with Takotsubo cardiomyopathy, and 16.2 +/- 4.3, 13.9 +/- 4.6, 7.9 +/- 4.6 and 5.0 +/- 4.5, respectively, in those with AMI. Abnormal myocardial fatty acid scores on 123I-BMIPP images were 12.6 +/- 3.7, 6.8 +/- 3.2 and 0.4 +/- 0.6 during the subacute, chronic and chronic II phases, respectively, in patients with Takotsubo cardiomyopathy, and 16.5 +/- 5.1, 14.7 +/- 4.8 and 7.5 +/- 4.5 in those with AMI. Abnormal myocardial sympathetic nerve function scores on 123I-MIBG images were 14.8 +/- 4.0, 8.8 +/- 4.0 and 0.4 +/- 0.6 during the subacute, chronic, chronic II phases, respectively, in patients with Takotsubo cardiomyopathy, and 18.6 +/- 6.5, 16.8 +/- 6.8 and 12.9 +/- 5.2 in those with AMI. Myocardial 99mTc-PYP uptake was abnormal not only in patients with AMI but also in those with Takotsubo cardiomyopathy during the acute phase.. Takotsubo cardiomyopathy might represent a stunned myocardium caused by a disturbance of the coronary microcirculation.

Topics: 3-Iodobenzylguanidine; Aged; Aged, 80 and over; Cardiomyopathies; Diagnosis, Differential; Fatty Acids; Female; Humans; Iodobenzenes; Male; Middle Aged; Myocardial Infarction; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Syndrome; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon; Ventricular Dysfunction, Left

We assessed Takotsubo (ampulla) cardiomyopathy compared with acute coronary syndrome (ACS) using two-dimensional echocardiography and 99mTc-tetrofosmin myocardial SPECT.. We examined 10 patients with Takotsubo cardiomyopathy and 16 with ACS at the time of emergency admission (acute phase), at three to nine days after the attack (subacute phase) and at one month after the attack (chronic phase). The left ventricle was divided into nine regions on echocardiograms and SPECT images, and the degree of abnormalities in each region was scored in five grades from normal (0) to severely abnormal (4).. Coronary angiography revealed total or subtotal occlusion in patients with ACS but no stenotic legions in those with Takotsubo cardiomyopathy. The amount of ST segment elevation (mm) was 7.9 +/- 3.4 in patients with Takotsubo cardiomyopathy and 7.3 +/- 3.7 in those with ACS (N.S.). Abnormal wall motion scores on echocardiograms were 13.8 +/- 4.4, 4.4 +/- 3.8 and 1.8 +/- 2.3 during the acute, subacute and chronic phases in patients with Takotsubo cardiomyopathy, and 13.9 +/- 4.0, 11.7 +/- 3.7, 7.6 +/- 4.2, respectively in patients with ACS. The value of MB fraction of creatine phosphokinase (IU/l) was 34 +/- 23 in patients with Takotsubo cardiomyopathy and 326 +/- 98 in those with ACS (p < 0.001). Abnormal myocardial perfusion scores on 99mTc-tetrofosmin myocardial SPECT were 11.4 +/- 3.2, 3.2 +/- 3.3 and 0.7 +/- 1.1 during the acute, subacute and chronic phases respectively, in patients with Takotsubo cardiomyopathy, and 15.8 +/- 4.1, 13.5 +/- 4.4, 8.2 +/- 4.4, respectively, in those with ACS. The numbers of myocardial segments that did not uptake 99mTc-tetrofosmin during the acute phase were 0.5 +/- 0.8 and 3.6 +/- 2.8 in patients with Takotsubo cardiomyopathy and ACS, respectively.. Impaired coronary microcirculation might be a causative mechanism of Takotsubo cardiomyopathy.

Topics: Acute Disease; Aged; Aged, 80 and over; Cardiomyopathies; Coronary Disease; Diagnosis, Differential; Female; Heart Ventricles; Humans; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Syndrome; Tomography, Emission-Computed, Single-Photon; Ventricular Dysfunction, Left

To validate functional analysis of gated SPECT in detecting myocardial viability, seventeen patients (male 15, female 2, mean age 58) with angiographically proven chronic ischemic heart disease (RCA 6, LAD 10, LCX 1) and eight normal volunteers (all male) were studied. All patients underwent 18F FDG PET and 99mTc tetrofosmin (TF) gated SPECT within a week. After being displayed in a polar map, myocardial perfusion was regionally determined by the mean count in 9 segments at end diastole (ED) and end systole (ES) in gated SPECT. Systolic function was determined by the count increase ratio from ED to ES (WTI: ES - ED/ED). Glucose metabolism was assessed by 18F FDG PET in the segments correspondent to those defined for SPECT. TF %uptake of < 60% was defined as hypoperfusion, and FDG %uptake of < 50% was defined as reduced glucose metabolism.. The myocardial segments were classified into 3 categories: "normal" perfusion (n = 85), "mismatch" (reduced perfusion with reserved FDG uptake, n = 25) and "matched" reduced perfusion and metabolic reduction (n = 26). Mean WTI in "mismatch" segment was 0.38 +/- 0.21, and was significantly greater than that in "matched reduced" segments, 0.15 +/- 0.20 (p < 0.001). It was also greater than that in "normal" segments, 0.27 +/- 0.16. Regression analysis showed that association between WTI and FDG %uptake was significant (r = 0.57, p < 0.0005) for the ischemic segments ("mismatch" + "matched", n = 51), but the association was weak for the entire segments although it was statistically significant (r = 0.26, p = 0.02, n = 136).. For the segments determined as infarct by perfusion image, systolic functional analysis by gated SPECT is helpful in differentiation of a viable myocardial region or artifact from a scar. Nevertheless, further clinical and technical assessment is required for ECG gating to eliminate overestimation of viability and to warrant clinical use.

Topics: Adult; Aged; Cardiomyopathies; Electrocardiography; Female; Fluorodeoxyglucose F18; Heart; Humans; Male; Middle Aged; Myocardium; Organophosphorus Compounds; Organotechnetium Compounds; Tomography, Emission-Computed; Tomography, Emission-Computed, Single-Photon

Myocardial relaxation at the diastolic phase was not evaluated by multi-gated myocardial SPECT, although myocardial contraction at the systolic phase was studied by percent wall thickening and Bull's eye methods. We make out a myocardial volume curve and report to evaluate the myocardial relaxation using multi-gated myocardial SPECT. The study population consisted of 3 normal human subjects (3 male, 32-37 years old), 10 idiopathic cardiomyopathy, 10 coronary artery disease and 1 hypertensive heart disease combined with aortic regurgitation. All cases were injected 555 MBq of 99mTc-tetrofosmin (Amersham Healthcare Corporation) intravenously at rest. A triple detector gamma-camera (GCA-9300A, Toshiba Medical, Japan) and a data processing computer (GMS-5500A, Toshiba Medical, Japan) were used in this study. A cardiac cycle (R-R interval) was divided by 16 frames (50-80 msec per 1 frame). Eight myocardial volume curves were calculated at the anterior wall, apex and inferior wall of the vertical long axis view and were calculated at the septal wall, apex and lateral wall of the horizontal long axis view, respectively. The patterns of the myocardial volume curves were classified into 5 patterns (Normal pattern (N), Delayed Contraction pattern (DC), Delayed Relaxation pattern (DR), Mixed pattern (M) and Normal pattern with Decreased amplitude (ND)). Myocardial uptake was evaluated visually of grading into severe hypertrophy (5), hypertrophy (4), normal (3), mild hypoperfusion (2), hypoperfusion (1) and perfusion defect (0). We compared patterns of the myocardial volume curves to myocardial uptake in the same segments. It was possible to detect myocardial edge of the total 16 frames with 50-60% threshold in the normal volunteer and in patients with hypertrophic cardiomyopathy and to make a myocardial volume curve. The region of the severe myocardial perfusion defect could be detected with 20% threshold in patients with old myocardial infarction. In comparison with myocardial volume curves and myocardial uptake, 74.6% in the N pattern had a normal uptake (3), 66.7% in the ND pattern had a normal uptake (3), 61.5% in the DC pattern had a hypoperfusion segment (0, 1 or fill-in to normal uptake), 44.4% in the DR pattern had a hypertrophic segment (4, 5 or fill-in to increased uptake). The pattern of myocardial volume curve indicates myocardial contractility and relaxation in each myocardial segment.

Topics: Adult; Aged; Cardiomyopathies; Diastole; Female; Gated Blood-Pool Imaging; Humans; Male; Middle Aged; Myocardial Contraction; Organophosphorus Compounds; Organotechnetium Compounds; Tomography, Emission-Computed, Single-Photon

The clinical usefulness of a new myocardial perfusion imaging agent, 99mTc-1,2-bis[bis(2-ethoxyethyl)phosphino]ethane (99mTc-Tetrofosmin, (PPN1011) was evaluated in 355 patients with various heart diseases. Both 1 and 2 day protocols resulted in images that were significantly clearer than those of 201Tl. The absence of significant drug related adverse reaction supported the safety of the agent for clinical use. Regional abnormalities detected by CAG agreed with 99mTc-Tetrofosmin SPECT findings in 74% and with 201Tl SPECT in 78% of this study. Eighty-four percent of an abnormalities were detected with 99mTc-Tetrofosmin SPECT, as compared with those detected with 201Tl SPECT (88.4%). The complete concordance ratio between 99mTc-Tetrofosmin and 201Tl images in segmental analysis was 87-89% at rest and stress. Since 99mTc-Tetrofosmin SPECT was judged clinically useful in 93.2% (331/355) of the patients studied, it is concluded that 99mTc-Tetrofosmin is a promising agent for myocardial perfusion imaging. The simple labeling procedure without heating and cooling is suitable for emergency administration. Reconditioning of myocardial perfusion could be evaluated with 99mTc-Tetrofosmin injection before and after interventional therapy. These are additional features of the agent for clinical use.

Topics: Adult; Aged; Aged, 80 and over; Angina Pectoris; Cardiomyopathies; Female; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Organophosphorus Compounds; Organotechnetium Compounds; Tomography, Emission-Computed, Single-Photon

The noninvasive differentiation of ischemic from nonischemic cardiomyopathy is clinically important. However, whether adenosine Tc-99m tetrofosmin SPECT can offer clear and accurate information was not known. The aim of this study is to investigate the usefulness of adenosine Tc-99m tetrofosmin SPECT in differentiation of ischemic from nonischemic etiology in patients with mild to severe LV systolic dysfunction and to compare the relationship between patients with mild LV systolic dysfunction and those with severe LV systolic dysfunction.. Seventy-five patients with chronic heart failure (LV ejection fraction 35%, group II (31 patients) had severe LV dysfunction, LVEF or=20%. Myocardial ischemia was defined by >or=70% stenosis in at least one vessel by coronary angiography.. : In group I, 4 (30.8%) of 13 patients with small defects, 1 (25.0%) of 5 patients with a medium defect, and 22 (84.6%) of 26 patients with large defects demonstrated myocardial ischemia documented by coronary angiography. The relationship between the extent of the SPECT defect and myocardial ischemia was statistically significant in the group I population (P < 0.001). However, in group II, 1 (33.3%) of 3 patients with small defect, 3 (33.3%) of 9 patients with medium defects, and 7 (36.8%) of 19 patients with large defects demonstrated myocardial ischemia confirmed by coronary angiography. There was no statistical relationship between the extent of the SPECT defect and myocardial ischemia in group II.. Adenosine Tc-99m tetrofosmin SPECT is a useful modality to differentiate ischemic from nonischemic etiology in patients with mild LV systolic dysfunction. However, other noninvasive approaches other this SPECT may be considered for confirming the etiology in patients with severe LV systolic dysfunction.

Topics: Aged; Cardiomyopathies; Coronary Angiography; Echocardiography; Female; Heart Failure; Humans; Male; Middle Aged; Myocardial Ischemia; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Systole; Tomography, Emission-Computed, Single-Photon; Ventricular Dysfunction, Left

A 70-year-old woman was admitted to our hospital because of left ventricular dysfunction, which was observed after permanent pacemaker implantation in another hospital. The left ventricular dysfunction was apical ballooning. Left ventriculography demonstrated takotsubo-like shape. However, the dysfunction did not improve immediately with medical treatment. In this case, 75% stenosis was observed in the left anterior descending artery. We suppose that this lesion corresponded to the delayed recovery of the dysfunction and performed coronary intervention. The takotsubo-like shape improved gradually for about 1 year. Whether the coronary intervention was effective for the recovery of the dysfunction is unclear, this clinical course was interesting in evaluating the delayed recovery of takotsubo-like left ventricular dysfunction.

Topics: Aged; Cardiomyopathies; Coronary Circulation; Electrocardiography; Female; Heart; Heart Block; Heart Ventricles; Humans; Myocardial Contraction; Organophosphorus Compounds; Organotechnetium Compounds; Pacemaker, Artificial; Radionuclide Imaging; Radiopharmaceuticals; Recovery of Function; Ultrasonography; Ventricular Dysfunction, Left

Topics: Aged; Carcinoid Tumor; Cardiomyopathies; Diagnosis, Differential; Heart; Humans; Male; Mediastinal Neoplasms; Organophosphorus Compounds; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Thymoma

Enhanced washout of 99mTc-tetrofosmin (TF) has been reported in patients with hypertrophic cardiomyopathy (HCM). Here, using quantitative dual-autoradiography, the relationship between TF retention abnormality and metabolism depicted by 125I-BMIPP uptake was investigated quantitatively in a hamster model of cardiomyopathy.. Early and delayed TF images were obtained at 5 min (7 cardiomyopathic and 5 normal hamsters) and 60 min (8 cardiomyopathic and 5 normal hamsters) after injection, respectively. BMIPP image was obtained 5 min after injection. Five cardiomyopathic and 5 normal hamsters were evaluated histologically. Percent uptake of TF and BMIPP in the heart was measured by an auto-well counter. The left ventricular wall was divided into 12 segments, and the relative regional uptake of TF and BMIPP was measured for each segment. Heterogeneity of radioactive distribution was determined by the standard deviation (SD) of radioactive counts in the left ventricular wall on autoradiogram. The uptake of early TF, delayed TF, and BMIPP in cardiomyopathic hamsters was 8.8%, 20.3%, and 25.3% lower than that in normal hamsters, p < 0.05, p < 0.01, and p < 0.001, respectively. In normal hamsters, distribution of radioactivity in all images was homogeneous, and the SD values were about 13. In cardiomyopathic hamsters, heterogeneous distribution was observed on all images, and the degree of heterogeneity was marked on delayed TF and BMIPP images. The SD was 19.7 +/- 1.2 for early TF image, 25.5 +/- 1.4 for delayed TF image, and 31.7 +/- 2.4 for BMIPP image, respectively. A weak linear correlation was observed between the relative regional uptake of the delayed TF and BMIPP in cardiomyopathic hamsters (r = 0.57). Electron microscopy demonstrated ultra-structural changes in mitochondria of cardiomyopathic hamsters.. Degree of retention abnormality on delayed TF image corresponded to the metabolic abnormality, probably due to mitochondrial dysfunction, depicted on BMIPP imaging.

Topics: Animals; Autoradiography; Cardiomyopathies; Cricetinae; Disease Models, Animal; Fatty Acids; Heart Ventricles; Image Interpretation, Computer-Assisted; Iodine Radioisotopes; Iodobenzenes; Mesocricetus; Metabolic Clearance Rate; Organophosphorus Compounds; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Tissue Distribution

An 84-year-old woman was admitted to hospital with chest pain at rest. An electrocardiogram showed ST-segment elevation in leads II, III, aV(F) and V(2-6), and the 2-dimension echocardiogram showed apical ballooning akinesis and basal hyperkinesis of both ventricles. (99m)Tc-tetrofosmin myocardial single photon emission computed tomography (SPECT) showed severely reduced uptake in the apex. Coronary angiography did not show any organic stenosis, and epicardial coronary spasm was not provoked by the ergonovine loading test. Left ventriculography showed apical ballooning akinesis and basal hyperkinesis, which were also apparent on right ventriculography. The coronary flow velocity pattern showed rapid diastolic acceleration and deceleration times, and the coronary flow reserve measured with a Doppler guide wire was severely decreased. (99m)Tc-tetrofosmin myocardial SPECT showed improvement in the findings after 14 days, and the coronary flow velocity pattern and coronary flow reserve improved after 30 days. Left and right ventriculography both revealed mild improvement in the wall motion. These findings suggested that a microcirculation disturbance caused ampulla ('Takotsubo') cardiomyopathy.

Topics: Aged; Aged, 80 and over; Blood Flow Velocity; Cardiomyopathies; Coronary Angiography; Coronary Circulation; Electrocardiography; Female; Heart Ventricles; Humans; Microcirculation; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon; Ultrasonography, Interventional

In order to evaluate the diagnostic efficacy of the 1-day separate acquisition dual-isotope single-photon emission computed tomography (SPECT) protocol, using 201Tl for the rest and 99mTc-tetrofosmin for the stress images, a consecutive series of patients with suspected or known coronary artery disease (CAD) was studied that also underwent coronary angiography.. The results of myocardial SPECT, using a semi-quantitative visual analysis, were acquired in 123 patients and compared with the results of coronary angiography. Sensitivity and specificity were calculated, using thresholds of > or = 50 and > or = 70% stenosis. As an alternative for specificity, the normalcy rate was determined in a separate group of 87 patients with a < 5% pre-test likelihood of CAD.. The prevalence of CAD using > or =50 and > or = 70% stenosis was 88 and 78%, respectively. The sensitivity for detection of patients with > or = 50 and > or = 70% stenosis was 94 and 97%, respectively while specificity was 62 and 59%, respectively. The high rate of false positive perfusion defects resulting in a low specificity could be explained by specific clinical issues. However, the routine assessment with additional clinical and electrocardiographic data resulted in a correct interpretation of most of the false positive perfusion defects. The positive predictive value was 92 and 85% and the negative predictive value 46 and 77%, using thresholds of > or = 50 and > or = 70% stenosis, respectively. The normalcy rate was 91%.. The one-day separate acquisition rest 201Tl/stress 99mTc-tetrofosmin SPECT protocol is an efficient procedure for myocardial perfusion scintigraphy with high sensitivity for detection of CAD. Specific clinical issues caused a low value for specificity. Therefore, clinical information and knowledge of the electrocardiogram is essential for a correct interpretation of SPECT images.

Topics: Adenosine; Adult; Aged; Aged, 80 and over; Cardiomyopathies; Coronary Angiography; Coronary Artery Disease; Echocardiography; Exercise Test; False Positive Reactions; Female; Humans; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Predictive Value of Tests; Prevalence; Radiopharmaceuticals; Risk Factors; Sensitivity and Specificity; Statistics as Topic; Stroke Volume; Tomography, Emission-Computed, Single-Photon; Vasodilator Agents

An 82-year-old woman was referred to the authors' institution because of an electrocardiographic abnormality mimicking acute myocardial infarction. Left ventriculography showed apical wall hypokinesis and basal wall hyperkinesis. Coronary angiography revealed no organic stenosis. Three days earlier, she was told she had renal cancer. She was diagnosed as having "takotsubo" cardiomyopathy. She underwent early and delayed Tc-99m tetrofosmin single photon emission computed tomography (SPECT). The early SPECT images revealed homogeneous tracer uptake in the left ventricle, but the delayed images revealed decreased uptake in the apical wall. Reverse redistribution of Tc-99m tetrofosmin was observed in this patient with "takotsubo" cardiomyopathy.

Topics: Aged; Aged, 80 and over; Cardiomyopathies; Diagnosis, Differential; Female; Heart; Humans; Organophosphorus Compounds; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Ventricular Dysfunction, Left

A 57-year-old woman was emergently admitted to our hospital because of chest oppression. On examination, blood pressure was 174/96 mmHg, pulse rate was 90/min and coarse crackle and third heart sound were audible. On laboratory data, the levels of LDH and CPK-MB were mildly elevated. Electrocardiogram (ECG) demonstrated elevation of the ST segment in leads I, aVL and V2-V5. 99mTc-tetrofosmin myocardial SPECT (TF) showed severely reduced uptake in the apex and anterior wall. Emergent coronary angiography (CAG) did not show any stenotic lesion. Left ventriculography (LVG), however, demonstrated akinesis of the apex, anterior, and inferior walls, and basal hyperkinesis. On the second hospital day, ECG demonstrated inverted T wave in leads I, aVL and V2-V5. 123I-BMIPP myocardial SPECT (BMIPP) and 123I-MIBG myocardial SPECT (MIBG) were performed on the second and fourth hospital days, respectively. These cardiac images showed severely reduced uptake equally. TF, BMIPP, and MIBG were re-examined on the eighth, tenth, and twelfth hospital days, respectively. MIBG, BMIPP, and TF showed reduced uptake in order of severity. On the fourteenth hospital day, CAG and LVG were re-examined. Coronary vasospasm provocation test was negative using ergonovine and acetylcholine, and LVG did not demonstrated any sign of asynergy. We considered that this case was "Takotsubo" cardiomyopathy and might be caused by microvascular spasm.

Topics: 3-Iodobenzylguanidine; Acute-Phase Reaction; Cardiomyopathies; Coronary Vasospasm; Fatty Acids; Female; Gated Blood-Pool Imaging; Heart; Humans; Iodine Radioisotopes; Iodobenzenes; Microcirculation; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon; Ventricular Dysfunction, Left

Topics: Antineoplastic Agents; Cardiomyopathies; Doxorubicin; Female; Heart; Humans; Middle Aged; Multiple Myeloma; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Ribs; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

We studied the causative mechanism of ampulla (Takotsubo) cardiomyopathy.. We examined 7 patients with ampulla cardiomyopathy by means of coronary angiography, two-dimensional echocardiography and 99Tc-tetrofosmin myocardial SPECT at the time of emergency admission (acute phase), at 3 to 5 days after the attack (subacute phase) and at 1 month after the attack (chronic phase). The left ventricle was divided into 9 regions on two-dimensional echocardiograms and 99mTc-tetrofosmin myocardial SPECT images, then the degree of abnormalities in each region was scored in four grades from normal (0) to severely abnormal (3). We injected nicorandil into the coronary arteries and determined the elevation in the ST segment before and after administration.. Coronary angiography did not show stenotic lesions in any patient. The acute, subacute and chronic phase myocardial perfusion scores on 99mTc-tetrofosmin myocardial SPECT were 11.2 +/- 3.4, 2.7 +/- 2.3 and 0.4 +/- 0.5, respectively, and wall motion scores on echocardiograms were 13.0 +/- 3.6, 4.4 +/- 2.2 and 0.6 +/- 0.6, respectively, indicating improvement in all scores during the subacute phase (p < 0.01). The elevation in the ST segment (mm) on the electrocardiogram was improved from 8.3 +/- 2.7 to 4.9 +/- 1.9 after the administration of nicorandil (p < 0.05).. These findings indicated that coronary microvascular spasm is one causative mechanism of ampulla cardiomyopathy.

Topics: Acute Disease; Aged; Cardiomyopathies; Chronic Disease; Coronary Angiography; Coronary Vasospasm; Echocardiography; Electrocardiography; Female; Humans; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon

We sought to determine whether right ventricular (RV) perfusion imaging with technetium-99m (Tc-99m) sestamibi or tetrofosmin single-photon emission computed tomography has diagnostic benefit for RV-originated ventricular tachyarrhythmias (RVT).. Identification of RV abnormalities is clinically important to establish RVT etiology.. Forty-seven patients with RVT (23 with idiopathic and 24 with organic RVT due to arrhythmogenic RV or dilated cardiomyopathy, cardiac sarcoidosis or myocarditis) were compared to 25 control subjects. Right ventricular uptake score, as assessed by modified tomographic imaging, and regional RV count relative to peak left ventricular (LV) count (RV/LV count ratio) were compared with RV regional and global function.. Regional RV uptake score correlated well with the RV/LV count ratio, and segmental abnormality was more frequently (p = 0.001) detected in the organic RVT group (22 [92%] of 24 patients) than in the idiopathic RVT group (4 [17%] of 23 patients) or the control group (8 [32%] of 25 patients). The total RV score (8.4+/-3.8) in the organic RVT group was significantly lower than that in the idiopathic RVT group (15.6+/-1.6) or the control group (15.1+/-1.8). The total RV score correlated with RV EF (r = 0.702, p<0.001). A total RV score <12 differentiated the organic RVT group from the other two groups, with a sensitivity of 79% and a specificity of 100%. The asynergic RV regions had a significantly lower RV/LV count ratio and RV score as compared with the nonasynergic regions and were identified by RV assessment, with a sensitivity of 76.1% and a specificity of 76.6%.. Right ventricular perfusion tomography using a Tc-99m-labeled tracer is clinically useful for the noninvasive detection of RV myocardial damage in patients with RVT and for differentiating organic from idiopathic RVT.

Topics: Adolescent; Adult; Aged; Cardiomyopathies; Child; Female; Heart Ventricles; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Radionuclide Ventriculography; Radiopharmaceuticals; Sensitivity and Specificity; Tachycardia, Ventricular; Technetium Tc 99m Sestamibi; Tomography, Emission-Computed, Single-Photon

Topics: Cardiomyopathies; Humans; Organophosphorus Compounds; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals