A Review of Nuclear Imaging in Takotsubo Cardiomyopathy.

Takotsubo cardiomyopathy or Takotsubo Syndrome (TTS) is a reversible left ventricular dysfunction syndrome that is increasingly being recognized. Recent advances in nuclear imaging have allowed us to study TTS in greater detail. We searched the PubMed and Medline databases and identified 53 publications with 221 patients reporting nuclear imaging findings in TTS. The age of the patients ranged from 17 to 87 years and were predominantly women (88.2%). The TTS variant was apical (typical) in 170 (76.9%), mid-ventricular in 23 (10.4%), and basal (reverse TTS) in 2 (0.9%). Cardiac perfusion was assessed using 99m Tc sestamibi (MIBI) SPECT, 99m Tc tetrofosmin SPECT, 201 Tl SPECT, 82 Rb PET, 201 Tl SPECT, and 13 N ammonia PET. Additional studies used were 123 I MIBG SPECT, 123 I BMIPP SPECT, 18 F FDG PET, 67 Ga citrate, and 11 C hydroxy-ephedrine. A perfusion defect was seen in 69 (31.2%), and an inverse perfusion-metabolism mismatch (normal or near-normal perfusion with absent myocardial metabolic activity) was seen in 183 (82.8%) patients. Nuclear imaging has a significant role in evaluating, diagnosing, and prognosticating patients with TTS. As nuclear imaging technology evolves, we will surely gain more insights into this fascinating disorder.