Yoshito Kadoya, Aun Yeong Chong, Gary R Small, Benjamin Chow, Robert deKemp, Terrence D Ruddy, Rob Beanlands, Andrew M Crean
{"title":"Takotsubo综合征的整体微血管功能障碍和不完全恢复：来自系列PET成像的见解。","authors":"Yoshito Kadoya, Aun Yeong Chong, Gary R Small, Benjamin Chow, Robert deKemp, Terrence D Ruddy, Rob Beanlands, Andrew M Crean","doi":"10.1161/CIRCIMAGING.125.018266","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The proposed cause of Takotsubo syndrome (TTS) includes coronary microvascular dysfunction. This study aimed to investigate coronary microvascular dysfunction and its recovery in patients with TTS using serial positron emission tomography myocardial perfusion imaging.</p><p><strong>Methods: </strong>Patients with TTS who underwent cardiac positron emission tomography within 30 days of admission and at 6-month follow-up (May 2017-June 2023) were analyzed. Changes in positron emission tomography parameters, including extent of myocardial perfusion abnormality, left ventricular function, rest and stress myocardial blood flow (MBF), myocardial flow reserve, and coronary vascular resistance (CVR), were assessed from baseline to follow-up. In apical TTS, segmental analyses (basal, mid, distal segments, and apex) and intersegment differences were evaluated.</p><p><strong>Results: </strong>Of 130 patients screened, 62 patients (median age, 70 years, 97% female) were included. After a median follow-up of 178 (121-282) days, global rest and stress MBF, myocardial flow reserve, and CVR significantly improved at follow-up (0.81-0.89 mL/min per gram, <i>P</i>=0.004; 1.56-2.61 mL/min per gram, <i>P</i><0.001; 1.96-2.65, <i>P</i><0.001; 52.0-36.2 mm Hg·min·g/mL, <i>P</i><0.001, respectively). Among 53 patients with apical TTS, improvements in stress MBF, myocardial flow reserve, and CVR were noted in all myocardial segments (all <i>P</i><0.001), including the basal segment; however, persistent MBF and CVR abnormalities were identified in the distal segment and apex, despite full recovery of left ventricular function.</p><p><strong>Conclusions: </strong>Patients who underwent serial positron emission tomography perfusion imaging for TTS demonstrated reversible reductions in rest and stress MBF, myocardial flow reserve, and increases in CVR, suggestive of TTS-related coronary microvascular dysfunction and subsequent subtotal recovery. Coronary microvascular dysfunction extended beyond regions of wall motion abnormalities, and regional coronary flow abnormalities persisted in the medium term even after recovery of left ventricular function.</p>","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e018266"},"PeriodicalIF":7.0000,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Global Microvascular Dysfunction and Incomplete Recovery in Takotsubo Syndrome: Insights From Serial PET Imaging.\",\"authors\":\"Yoshito Kadoya, Aun Yeong Chong, Gary R Small, Benjamin Chow, Robert deKemp, Terrence D Ruddy, Rob Beanlands, Andrew M Crean\",\"doi\":\"10.1161/CIRCIMAGING.125.018266\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The proposed cause of Takotsubo syndrome (TTS) includes coronary microvascular dysfunction. This study aimed to investigate coronary microvascular dysfunction and its recovery in patients with TTS using serial positron emission tomography myocardial perfusion imaging.</p><p><strong>Methods: </strong>Patients with TTS who underwent cardiac positron emission tomography within 30 days of admission and at 6-month follow-up (May 2017-June 2023) were analyzed. Changes in positron emission tomography parameters, including extent of myocardial perfusion abnormality, left ventricular function, rest and stress myocardial blood flow (MBF), myocardial flow reserve, and coronary vascular resistance (CVR), were assessed from baseline to follow-up. In apical TTS, segmental analyses (basal, mid, distal segments, and apex) and intersegment differences were evaluated.</p><p><strong>Results: </strong>Of 130 patients screened, 62 patients (median age, 70 years, 97% female) were included. After a median follow-up of 178 (121-282) days, global rest and stress MBF, myocardial flow reserve, and CVR significantly improved at follow-up (0.81-0.89 mL/min per gram, <i>P</i>=0.004; 1.56-2.61 mL/min per gram, <i>P</i><0.001; 1.96-2.65, <i>P</i><0.001; 52.0-36.2 mm Hg·min·g/mL, <i>P</i><0.001, respectively). Among 53 patients with apical TTS, improvements in stress MBF, myocardial flow reserve, and CVR were noted in all myocardial segments (all <i>P</i><0.001), including the basal segment; however, persistent MBF and CVR abnormalities were identified in the distal segment and apex, despite full recovery of left ventricular function.</p><p><strong>Conclusions: </strong>Patients who underwent serial positron emission tomography perfusion imaging for TTS demonstrated reversible reductions in rest and stress MBF, myocardial flow reserve, and increases in CVR, suggestive of TTS-related coronary microvascular dysfunction and subsequent subtotal recovery. Coronary microvascular dysfunction extended beyond regions of wall motion abnormalities, and regional coronary flow abnormalities persisted in the medium term even after recovery of left ventricular function.</p>\",\"PeriodicalId\":10202,\"journal\":{\"name\":\"Circulation: Cardiovascular Imaging\",\"volume\":\" \",\"pages\":\"e018266\"},\"PeriodicalIF\":7.0000,\"publicationDate\":\"2025-09-03\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Circulation: Cardiovascular Imaging\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1161/CIRCIMAGING.125.018266\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Circulation: Cardiovascular Imaging","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1161/CIRCIMAGING.125.018266","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Global Microvascular Dysfunction and Incomplete Recovery in Takotsubo Syndrome: Insights From Serial PET Imaging.
Background: The proposed cause of Takotsubo syndrome (TTS) includes coronary microvascular dysfunction. This study aimed to investigate coronary microvascular dysfunction and its recovery in patients with TTS using serial positron emission tomography myocardial perfusion imaging.
Methods: Patients with TTS who underwent cardiac positron emission tomography within 30 days of admission and at 6-month follow-up (May 2017-June 2023) were analyzed. Changes in positron emission tomography parameters, including extent of myocardial perfusion abnormality, left ventricular function, rest and stress myocardial blood flow (MBF), myocardial flow reserve, and coronary vascular resistance (CVR), were assessed from baseline to follow-up. In apical TTS, segmental analyses (basal, mid, distal segments, and apex) and intersegment differences were evaluated.
Results: Of 130 patients screened, 62 patients (median age, 70 years, 97% female) were included. After a median follow-up of 178 (121-282) days, global rest and stress MBF, myocardial flow reserve, and CVR significantly improved at follow-up (0.81-0.89 mL/min per gram, P=0.004; 1.56-2.61 mL/min per gram, P<0.001; 1.96-2.65, P<0.001; 52.0-36.2 mm Hg·min·g/mL, P<0.001, respectively). Among 53 patients with apical TTS, improvements in stress MBF, myocardial flow reserve, and CVR were noted in all myocardial segments (all P<0.001), including the basal segment; however, persistent MBF and CVR abnormalities were identified in the distal segment and apex, despite full recovery of left ventricular function.
Conclusions: Patients who underwent serial positron emission tomography perfusion imaging for TTS demonstrated reversible reductions in rest and stress MBF, myocardial flow reserve, and increases in CVR, suggestive of TTS-related coronary microvascular dysfunction and subsequent subtotal recovery. Coronary microvascular dysfunction extended beyond regions of wall motion abnormalities, and regional coronary flow abnormalities persisted in the medium term even after recovery of left ventricular function.
期刊介绍：
Circulation: Cardiovascular Imaging, an American Heart Association journal, publishes high-quality, patient-centric articles focusing on observational studies, clinical trials, and advances in applied (translational) research. The journal features innovative, multimodality approaches to the diagnosis and risk stratification of cardiovascular disease. Modalities covered include echocardiography, cardiac computed tomography, cardiac magnetic resonance imaging and spectroscopy, magnetic resonance angiography, cardiac positron emission tomography, noninvasive assessment of vascular and endothelial function, radionuclide imaging, molecular imaging, and others.
Article types considered by Circulation: Cardiovascular Imaging include Original Research, Research Letters, Advances in Cardiovascular Imaging, Clinical Implications of Molecular Imaging Research, How to Use Imaging, Translating Novel Imaging Technologies into Clinical Applications, and Cardiovascular Images.
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