Myocardial perfusion and fatty acid metabolism in patients with tako-tsubo-like left ventricular dysfunction

Satoshi Kurisu, Ichiro Inoue, Takuji Kawagoe, Masaharu Ishihara, Yuji Shimatani, Kenji Nishioka, Takashi Umemura, Suji Nakamura, Masashi Yoshida, Hikaru Sato

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Abstract

OBJECTIVES: We sought to assess myocardial perfusion and metabolism in patients with peculiar transient asynergy, which consisted of basal normokinesia and apical akinesia of the left ventricle (LV) at the same time. BACKGROUND: This asynergy has been widely called "tako-tsubo-like LV dysfunction" in Japan, but little is known about its pathophysiology. METHODS: We performed rest tallium-201 (201T1) and iodine-123-beta-methyl-p-iodophenyl pentadecanoic acid (123I-BMIPP) dual-isotope myocardial single-photon emission computed tomography (SPECT) in 14 patients with tako-tsubo-like LV dysfunction. The LV was divided into 17 segments, and each segment was graded with scores between normal uptake (0) and defect (4). We also measured the Thrombolysis in Myocardial Infarction trial (TIMI) frame count in 28 patients and 20 control subjects. RESULTS: Early SPECT (5 ± 3 days) revealed that the total defect score value with BMIPP was significantly higher than reduced uptake with 201T1 (p < 0.01). Reduced uptake of BMIPP was observed in parallel with an apical akinetic region and usually involved uptake of 201T1. This discrepancy improved gradually during the follow-up period (29 ± 6 days) (p = 0.36). Compared with control subjects, patients had a TIMI frame count that was significantly higher in all coronary arteries immediately after onset. This higher TIMI frame count decreased but was sustained even after resolution of tako-tsubo-like LV dysfunction. CONCLUSIONS: Our data suggest that myocardial fatty acid metabolism is more severely impaired than myocardial perfusion, in parallel with an apical akinetic region during the early phase, and that impaired multivessel coronary microcirculation is involved, at least in part, in tako-tsubo-like LV dysfunction.

Original languageEnglish
Pages (from-to)743-748
Number of pages6
JournalJournal of the American College of Cardiology
Volume41
Issue number5
DOIs
Publication statusPublished - Mar 5 2003

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ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Kurisu, S., Inoue, I., Kawagoe, T., Ishihara, M., Shimatani, Y., Nishioka, K., Umemura, T., Nakamura, S., Yoshida, M., & Sato, H. (2003). Myocardial perfusion and fatty acid metabolism in patients with tako-tsubo-like left ventricular dysfunction. Journal of the American College of Cardiology, 41(5), 743-748. https://doi.org/10.1016/S0735-1097(02)02924-8