Emotional Stress-Induced `Ampulla Cardiomyopathy' Discrepancy Between the Metabolic and Sympathetic Innervation Imaging Performed During the Recovery Course

Mafumi Owa; Kazunori Aizawa; Nobuyuki Urasawa; Hiroyuki Ichinose; Kazuya Yamamoto; Koji Karasawa; Mitsuru Kagoshima; Jun Koyama; Shu-ichi Ikeda

doi:10.1253/jcj.65.349

Case Report

Emotional Stress-Induced `Ampulla Cardiomyopathy'

Discrepancy Between the Metabolic and Sympathetic Innervation Imaging Performed During the Recovery Course

Mafumi Owa, Kazunori Aizawa, Nobuyuki Urasawa, Hiroyuki Ichinose, Kazuya Yamamoto, Koji Karasawa, Mitsuru Kagoshima, Jun Koyama, Shu-ichi Ikeda

Author information

Mafumi Owa
Third Department of Internal Medicine, Shinshu University School of Medicine
Kazunori Aizawa
Third Department of Internal Medicine, Shinshu University School of Medicine
Nobuyuki Urasawa
Third Department of Internal Medicine, Shinshu University School of Medicine
Hiroyuki Ichinose
Third Department of Internal Medicine, Shinshu University School of Medicine
Kazuya Yamamoto
Third Department of Internal Medicine, Shinshu University School of Medicine
Koji Karasawa
Third Department of Internal Medicine, Shinshu University School of Medicine
Mitsuru Kagoshima
Third Department of Internal Medicine, Shinshu University School of Medicine
Jun Koyama
Third Department of Internal Medicine, Shinshu University School of Medicine
Shu-ichi Ikeda
Third Department of Internal Medicine, Shinshu University School of Medicine

Keywords: I-123-b-metyl-iodophenyl pentadecanoic acid (BMIPP), Ampulla cardiomyopathy, I-123-metaiodobenzyl-guanidine (MIBG), Takotsubo cardiomyopathy

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2001 Volume 65 Issue 4 Pages 349-352

DOI https://doi.org/10.1253/jcj.65.349

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Abstract

Four patients had the clinical features of `ampulla cardiomyopathy', consisting of acute-onset transient left ventricular apical akinesis with basal normokinesis, normal coronary angiogram, ST-segment elevation and subsequent giant T wave inversion, which mimicked acute coronary syndrome, the onset of which occurred shortly after extreme mental stress. Myocardial necrosis was minimal, although 2 patients showed elevated serum catecholamine levels in the acute phase. Each patient underwent serial cardiac radionuclide single-photon emission computed tomography of myocardial functional sympathetic innervation, fatty acid metabolism and perfusion using I-123-metaiodobenzyl-guanidine (MIBG), I-123-β-metyl-iodophenyl pentadecanoic acid (BMIPP) and thallium-201 (²⁰¹Tl), respectively. In the acute phase, MIBG and BMIPP imaging showed an uptake defect in the apical region, whereas ²⁰¹Tl uptake was mildly decreased. When assessed semi-quantitatively, the MIBG images had higher defect scores from the acute phase throughout the year of observation compared with BMIPP, and ²⁰¹Tl. These observations suggest that the primary cause of ampulla cardiomyopathy is related to a disturbance of the cardiac sympathetic innervation. (Jpn Circ J 2001; 65: 349 - 352)

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