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CLINICAL STUDY: ACUTE APICAL BALLOONING

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

^* Division of Cardiology, Hiroshima City Hospital, Hiroshima, Japan

Manuscript received July 16, 2002; revised manuscript received October 14, 2002, accepted October 31, 2002.

^* Reprint requests and correspondence: Dr. Satoshi Kurisu, Division of Cardiology, Hiroshima City Hospital, 7-33, Moto-machi, Naka-ku, Hiroshima, Japan 730-8518.
skurisu{at}nifty.com

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 (²⁰¹Tl) and iodine-123-beta-methyl-p-iodophenyl penta-decanoic 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 ²⁰¹Tl (p < 0.01). Reduced uptake of BMIPP was observed in parallel with an apical akinetic region and usually involved uptake of ²⁰¹Tl. 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.

Abbreviations and Acronyms   123I-BMIPP   iodine-123-beta-methyl-p-iodophenyl penta-decanoic acid   CAD   coronary artery disease   LCx   left circumflex artery   LV   left ventricle or ventricular   MI   myocardial infarction   RCA   right coronary artery   SPECT   single-photon emission computed tomography   TDS   total defect score   TIMI   Thrombolysis In Myocardial Infarction trial   201Tl   thallium-201

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