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Background:: Left ventricular dysfunction as part of takotsubo syndrome is reversible, and the long-term prognosis appears favorable. However, life-threatening complications are not uncommon during the acute phase, and it remains unclear whether renal dysfunction is a factor in complications suffered by hospitalized patients with takotsubo syndrome. The present study was conducted to investigate the implications of renal dysfunction in this setting., Methods:: Data from 61 consecutive patients (male, 21; female, 40) diagnosed with takotsubo syndrome at our hospital between years 2010 and 2016 were evaluated retrospectively. In-hospital complications by definition were all-cause deaths and severe pump failure (Killip class ≥III)., Results:: Overall, 30 patients (49%) developed renal dysfunction. In the 32 patients (52%) who suffered in-hospital complications (mortality, 10; severe pump failure, 22), estimated glomerular filtration rate (eGFR) was significantly lower by comparison (51.3±29.8 vs. 69.5±29.0; p=0.019). Low eGFR (<30 ml/min per 1.73m 2 ) proved independently predictive of in-hospital complications (hazard ratio =2.84, 95% confidence interval: 1.20-6.69) in multivariate Cox hazard analysis, also showing a significant association with peak event rate of Kaplan-Meier curve (log-rank test, p=0.0073). Similarly, patients with chronic kidney disease were at significantly greater risk of in-hospital complications (hazard ratio=2.49, 95% confidence interval: 1.01-5.98), relative to non-compromised counterparts (eGFR >60 ml/min per 1.73m 2 )., Conclusion:: Renal dysfunction is a simple but useful means of predicting complications in hospitalized patients with takotsubo syndrome, especially those with chronic kidney disease.

Background: For assessment of cardiac sympathetic nervous activity, the conventional protocol for iodine-123-metaiodobenzylguanidine ((123)I-MIBG) imaging requires several hours., Methods and Results: To establish whether it is possible to shorten the conventional (123)I-MIBG imaging protocol, anterior planar imaging was performed in 42 heart failure (HF) patients at 5, 15 and 180 min. The washout rate of (123)I-MIBG from 5 to 15 min (WR5-15 min) was calculated as a novel index. WR5-15 min closely correlated with the conventional washout rate and inversely correlated with the heart to mediastinum ratio. Univariate Cox analysis revealed that rapid WR5-15 min, augmented plasma B-type natriuretic peptide level, and decreased left ventricular ejection fraction (LVEF) were predictors for cardiac events. Multivariate analysis showed WR5-15 min and LVEF were independent predictors. The cardiac event rate was markedly higher (73%) in patients when both WR5-15 min and LVEF were abnormal., Conclusions: WR5-15 min obtained from anterior planar imaging is useful for evaluating the severity of HF and clinical outcome, and may shorten the cardiac (123)I-MIBG scintigraphy protocol.

Partial atrial standstill is characterized by the failure of atrial activity either spontaneously or in response to electrical stimulation in restricted site of atria. In this case with bradycardia, atrial standstill was restricted to the lateral and posterior right atrium. The markedly prolonged intraatrial conduction delay was observed in the superior to septal region of the right atrium. The electroanatomical mapping was successfully utilized to estimate atrial activity and to find a suitable site for atrial lead placement. The electroanatomical mapping may become an innovated strategy to estimate atrial electrical status in partial atrial standstill.

A mass was identified in the atrial septum by clinical imaging in a patient who had multiple large lipomas of the skin. Multislice computed tomography and magnetic resonance imaging indicated that the interatrial mass was a fatty infiltration. In order to discriminate the myocardial lesion from myxoma and other benign conditions and malignant tumors, percutaneous transvenous biopsy was performed. Microscopic examination demonstrated the cardiac mass to be lipomatous hypertrophy of the interatrial septum (LHIS), and the skin lesions, simple lipomas. The LHIS is itself a rare condition, and its development in patients having multiple ponderous lipomas, or lipomatosis, could not be found in a previous report. This may be the first published case of LHIS, which likely represents cardiac involvement of lipomatosis.

Unlabelled: The aim of this study was to clarify the clinical implications of decreased myocardial uptakes of 123I-labeled beta-methyl-p-iodophenyl-pentadecanoic acid (123I-BMIPP) in patients with unstable angina., Methods: Fatty acid metabolic imaging with 123I-BMIPP was performed in 20 patients with unstable angina during the pain-free state. Regional uptakes of 123I-BMIPP were scored semiquantitatively, and clinical characteristics and angiographic findings were compared between the patients with the normal and abnormal 123I-BMIPP images., Results: There were 9 patients with normal and 11 patients with abnormal 123I-BMIPP images. Severe coronary stenosis exceeding 90% (91% compared with 44%, p < 0.05) and 99% (82% compared with 0%, p < 0.01) and collateral opacification (36% compared with 0%, p < 0.05) were more frequently observed in patients with abnormal 123I-BMIPP images than in those with normal images. Percutaneous transluminal coronary angioplasty or coronary artery bypass grafting was performed in 22% of patients with normal 123I-BMIPP images and in 82% of patients with abnormal 123I-BMIPP images (p < 0.01)., Conclusion: Fatty acid metabolic imaging with 123I-BMIPP can determine the functional severity of coronary artery disease and is helpful for a clinical judgment in interventional treatment.

Unlabelled: A pattern of reverse redistribution (RR) has not been documented in myocardial 99mTc-sestamibi imaging. The purpose of the study was to clarify the time-related changes in myocardial distribution of 99mTc-sestamibi in patients with acute myocardial infarction., Methods: Myocardial SPECT with 99mTc-sestamibi was performed in 27 patients with acute myocardial infarction within 1 wk after the onset. Twenty-three patients received direct percutaneous transluminal coronary angioplasty (PTCA) and 4 patients did not. Myocardial images were obtained 1 hr (early) and 3 hr (delayed) after the injection of 99mTc-sestamibi. Regional myocardial uptake of 99mTc-sestamibi was scored from 4 (normal) to 0 (no activity), and the RR pattern was defined as a decrease of more than 1 in the regional score at the 3-hr delayed images. Regional myocardial uptake and clearance of 99mTc-sestamibi was also assessed quantitatively. Coronary arteriography and left ventriculography were performed 1 mo later., Results: Out of 22 patients with successful PTCA, RR of 99mTc-sestamibi was observed in 15 patients (68%). Persistent defects (PD) were seen in 12 patients (7 patients with successful PTCA, 1 patient with unsuccessful PTCA, and 4 patients who did not receive angioplasty). In patients with RR, regional uptake of 99mTc-sestamibi in the area of myocardial infarction decreased from 54% +/- 10% in the early images to 43% +/- 8% in the delayed images (p < 0.01). Technetium-99m-sestamibi clearance from the myocardium was faster in the infarct area than in the normal area (26% +/- 7% versus 9% +/- 6%, p < 0.01). Coronary arteriography performed 1 mo later revealed that the patency of the infarct related artery was 100% (15/15) in patients with RR and 50% (6/12) in those with PD (p < 0.01). The extent and severity of a wall motion abnormality were less in patients with RR than in those with PD (extent: 24 +/- 10 versus 36 +/- 9 chord, p < 0.01; severity: -2.7 +/- 0.4 versus -3.4 +/- 0.6 s.d./chord, p < 0.01)., Conclusion: The RR of 99mTc-sestamibi was observed in 68% of patients after successful direct PTCA and was associated with the accelerated clearance of 99mTc-sestamibi from the myocardium. The presence of RR in 99mTc-sestamibi imaging indicates the patency of the infarct-related artery and predicts the preserved left ventricular function.

The present study was undertaken to determine the potential diagnostic value of 123I-BMIPP scintigraphy for the detection of altered myocardial fatty acid metabolism in patients with unstable angina. Both myocardial metabolic imaging with 123I-BMIPP and perfusion imaging with 99mTc-sestamibi were performed at rest in 28 patients with unstable angina in the pain-free state. The regional uptakes of 123I-BMIPP or 99mTc-sestamibi were scored semiquantitatively (0 = normal, 4 = no activity) and compared with the coronary arteriographic findings. Decreased uptakes of 123I-BMIPP were observed in 18 patients, and 11 patients had abnormal 99mTc-sestamibi images. Defect scores of 123I-BMIPP were larger than those of 99mTc-sestamibi (7.8 +/- 2.1 vs. 5.2 +/- 1.9, p < 0.01). The sensitivity for the detection of patients with unstable angina was higher in 123I-BMIPP than in 99mTc-sestamibi (77% vs. 45%, p < 0.01). The site of the decreased 123I-BMIPP uptake corresponded to the most stenotic coronary artery lesion in all patients. Fatty acid metabolic imaging with 123I-BMIPP was more sensitive for detecting myocardial ischemia than perfusion imaging with 99mTc-sestamibi. 123I-BMIPP may be a clue to define the culprit lesion in unstable angina and be helpful to decide the best treatment and guide coronary angioplasty.

To test the feasibility of myocardial 123I-MIBG and 123I-BMIPP imaging for the early detection of anthracycline cardiotoxicity, 13 patients who had received anthracycline anticancer chemotherapeutic agents were studied. Two-dimensional echocardiography and myocardial imaging with both 123I-MIBG and 123I-BMIPP were performed in 13 patients treated with anthracycline (group A) and 10 normal control subjects (group C). Anterior myocardial images were obtained 15 minutes and 3 hours after the injection of isotopes. The heart-to-mediastinum ratio (H/M ratio) was used to quantify cardiac 123I-MIBG and 123I-BMIPP uptake. The left ventricular shortening fraction (%SF) and the ratio of peak mitral flow velocity in early diastole to that at the time of atrial systole (E/A ratio) were measured by echocardiography. The H/M ratio of 123I-MIBG was lower in group A than in group C (1.5 +/- 0.2 vs. 1.9 +/- 0.2, p < 0.01). The patients in group A had faster clearance of 123I-MIBG from the myocardium than those in group C (27 +/- 10% vs. 22 +/- 4%, p < 0.05). However, the H/M ratio and clearance of 123I-BMIPP were similar between the two groups (H/M ratio: 2.1 +/- 0.2 vs. 2.0 +/- 0.2, clearance: 24 +/- 6% vs. 26 +/- 6%). The %SF (37 +/- 8% vs. 36 +/- 7%) and E/A ratio (1.4 +/- 0.4 vs. 1.6 +/- 0.3) were comparable in groups A and C. The present findings indicated that myocardial imaging with 123I-MIBG could detect myocardial damage in patients treated with anthracycline in the early stage when cardiac systolic and diastolic function was still preserved. Early detection of anthracycline cardiotoxicity by 123I-MIBG would reduce the incidence and severity of heart failure.

The functional response of the left ventricle with scar to increased afterload, was examined in 15 patients with old myocardial infarction and left ventricular aneurysm (OMI). Interventional cine left ventriculography during elevating left ventricular pressure with methoxamine. Wall motion was assessed by the radial and the centerline method. Augmented afterload didn't change ejection fraction in patients with OMI, but normalized wall motion (Z) increased in the aneurysmal region and decreased in the remote region in both methods. In the remote region in patients with OMI, afterload stress shortened left ventricular pressure-radial length (P-L) loops along length axis, and reduced percent systolic radial shortening (SS). In the aneurysmal region, P-L loops showed systolic elongation of length at rest and the slope of end-diastolic point to end-systolic point became steeper with increased afterload, resulting in a decrease of aneurysmal expansion. In summary, with increasing afterload, wall motion decreased in non-infarcted regions and increased in aneurysmal regions, in left ventricles with aneurysm. This mechanism may be interpreted as afterload-induced shifts of P-L loops in each region.