A pathophysiologic study of tako-tsubo cardiomyopathy with F-18 fluorodeoxyglucose positron emission tomography

Eur Heart J. 2007 Nov;28(21):2598-604. doi: 10.1093/eurheartj/ehm401. Epub 2007 Oct 7.


AIMS; Our study aims to investigate the pathophysiologic mechanism underlying tako-tsubo cardiomyopathy using F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET).

Methods and results: Fifteen patients with tako-tsubo cardiomyopathy were enrolled in this study. Plasma catecholamines, cardiac troponin T (cTnT), and D-dimer were serially evaluated in all patients. Thallium-201 ((201)Tl) single-photon emission computed tomography (SPECT) and F-18 FDG PET were performed in 10 and eight patients, respectively. Emotional or physical stress occurred in 12 (80.0%) patients. ST-T segment abnormalities existed in all patients. Thirteen patients exhibited mildly elevated cTnT, although coronary angiography did not reveal significant stenosis in any patient. Endomyocardial biopsy specimens (n = 9) demonstrated contraction-band necrosis (n = 4) and mononuclear cell infiltration (n = 3). The levels of norepinephrine and epinephrine peaked on admission (744 +/- 452 and 140 +/- 166 pg/mL, respectively). There was severely reduced uptake at the apex on F-18 FDG PET image, despite slightly reduced uptake of (201)Tl. Elevation of D-dimer was observed in nine patients.

Conclusion: The extent of metabolic defect involving apical akinetic area was more severe than perfusion abnormality. Our data suggest that sudden emotional or physical stress may cause a catecholamine-induced metabolic disorder in the myocardium, which is probably central to this syndrome.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Biomarkers / blood
  • Cardiac Catheterization / methods
  • Catecholamines / blood
  • Coronary Angiography / methods
  • Echocardiography / methods
  • Electrocardiography / methods
  • Female
  • Fibrin Fibrinogen Degradation Products / metabolism
  • Fluorodeoxyglucose F18
  • Humans
  • Male
  • Positron-Emission Tomography / methods*
  • Radiopharmaceuticals
  • Takotsubo Cardiomyopathy / diagnostic imaging*
  • Takotsubo Cardiomyopathy / etiology
  • Takotsubo Cardiomyopathy / metabolism
  • Thallium Radioisotopes
  • Tomography, Emission-Computed, Single-Photon / methods*
  • Troponin T / blood


  • Biomarkers
  • Catecholamines
  • Fibrin Fibrinogen Degradation Products
  • Radiopharmaceuticals
  • Thallium Radioisotopes
  • Troponin T
  • fibrin fragment D
  • Fluorodeoxyglucose F18