Prolonged ST-Segment Elevation and Persistent Left Ventricular Dysfunction Assessed by Dual-Isotope Myocardial Scintigraphy in Takotsubo Syndrome: A Case Report

Takotsubo syndrome is characterized by transient left ventricular (LV) systolic dysfunction in the absence of obstructive coronary artery disease. ST-segment elevation is frequently observed in the acute phase and typically resolves within several days, evolving into T-wave inversion. Prolonged ST-segment elevation is uncommon, and its clinical significance remains incompletely understood. Here, we report the case of an elderly woman with takotsubo syndrome likely triggered by a urinary tract infection. The initial electrocardiogram showed marked ST-segment elevation with terminal T-wave inversion in leads V3-V6, with a maximum elevation of 3 mm in lead V4. ST-segment elevation persisted for at least 20 days, accompanied by persistent severe LV wall motion abnormalities and systemic inflammation, as evidenced by sustained elevation of C-reactive protein. Coronary angiography revealed no obstructive coronary artery disease. Furthermore, dual-isotope myocardial scintigraphy using 201Tl and 123I-β-methyl-p-iodophenyl-pentadecanoic acid (BMIPP) revealed a marked perfusion-metabolism mismatch, with moderately reduced 201Tl uptake and severely reduced 123I-BMIPP uptake in the dysfunctional segments. This case suggests that recovery of LV function may occasionally be incomplete or substantially delayed, particularly in the context of systemic inflammation.