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

Eur J Nucl Med Mol Imaging. 2010 Apr;37(4):765-72. doi: 10.1007/s00259-009-1362-z. Epub 2010 Jan 27.

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 + or - 0.20 vs 0.95 + or - 0.11 (p < 0.05), -1.7 + or - 6% vs 4 + or - 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.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anger
  • Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography*
  • Comorbidity
  • Female
  • Humans
  • Imagination
  • Male
  • Middle Aged
  • Motion
  • Myocardial Perfusion Imaging
  • Speech
  • Stress, Psychological / physiopathology*
  • Stroke Volume
  • Sympathetic Nervous System / physiopathology*
  • Takotsubo Cardiomyopathy / psychology*
  • Vasodilation