南予医誌 Vol.14 No. １ 2013－66－uptake ratio of the delayed images was 1.96 and the washout rate was 45.9%, demon-strating noradrenergic dysfunction (Figure 5A). Left ventriculography performed 20 days after admission demonstrated normal wall motion with a left ventricular ejection fraction of 75% (Figure 3C). Intracoronary ergonovine could not provoke any vaso-spasm. Her CFR recovered by 2.2-fold after ATP administration (Figure 4B). Before discharge, I-123-MIBG myocardial scin-tigraphy demonstrated an increase in the heart–mediastinal ratio (2.12) and washout rate (56.7%) (Figure 5B). No adverse car-diac events occurred during hospitalization, and the patient was discharged on day 22. Six months later, cardiac catheterization was performed, and a left ventriculogram demonstrated no wall motion abnormality. Her CFR recovered by 2.4-fold after ATP administration (Figure 4C). In addition, I-123-MIBG myocardial scintigraphy re-vealed further functional improvement of myocardial adrenergic dysfunction (Figure 5C).Discussion The prognosis of ampulla cardiomyopa-thy is usually considered to be good, and ampulla-like left ventricular asynergy usu-ally resolves within several weeks.2-4 With regard to its clinical course, Tsuchihashi et al.2 reported that 1% of in-hospital deaths were documented in a multicenter retro-Figure 5: Serial bull’s eye images of MIBG myocardial scintigraphic images in the acute phase (A), at discharge (B), and at 6 months (C). MIBG images demonstrated persistent uptake defects, especially in the apical region, throughout the follow-up period.ABCEarly delayWashout rateWOR 45.9%WOR 66.3%WOR 56.7%early H/M 2.11delay H/M 1.96early H/M 2.41delay H/M 1.78early H/M 2.73delay H/M 2.12Figure 5
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