title: Diagnostic value of contrast echocardiography in Tako-Tsubo cardiomyopathy.
abstract: BACKGROUND
  Tako-Tsubo cardiomyopathy is a clinical entity mimicking acute coronary syndrome. Assessment of left ventricular function may be difficult using conventional echocardiography.
  
  
  OBJECTIVE
  to characterize left ventricular systolic function using contrast echocardiography in Tako-Tsubo cardiomyopathy.
  
  
  METHODS
  We prospectively studied 63 consecutive women admitted for suspected acute coronary syndrome who underwent coronary arteriography, biplane left ventricular angiography and conventional and contrast echocardiography; 25 women had Tako-Tsubo cardiomyopathy (group 1), 25 women had proven coronary artery disease (group 2) and 13 women had no significant coronary lesion (group 3). Echocardiographic interpretation was performed by two observers: a physician trainee (observer 1) and an experienced investigator (observer 2).
  
  
  RESULTS
  Left ventricular segments were assessed for wall motion abnormalities, which were present in 70 and 88% (observer 1) and in 91 and 99% (observer 2), using conventional and contrast echocardiography, respectively (P<0.0001). Accuracy for the diagnosis of Tako-Tsubo cardiomyopathy was improved significantly for both observers using contrast echocardiography: for observer 1, sensitivity was 56 and 88%, respectively, using conventional and contrast echocardiography (P=0.01), whereas for observer 2, sensitivity was 72 and 96%, respectively (P=0.04). Interobserver agreement was excellent using contrast agent (kappa=0.85 vs 0.34 using conventional echocardiography). The blinded review of left ventriculograms distinguished Tako-Tsubo cardiomyopathy from coronary artery disease correctly in 96% of cases.
  
  
  CONCLUSIONS
  Contrast echocardiography could be used in routine practice to replace left ventricular angiography in Tako-Tsubo cardiomyopathy.
authors.affiliation: Service de Cardiologie, Hôpital Universitaire Ambroise-Paré, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Versailles-Saint-Quentin (UVSQ), 92100 Boulogne, France. nicolas.mansencal@apr.aphp.fr
authors.forename: Nicolas
authors.initials: N
authors.lastname: Mansencal
authors.forename: Denis
authors.initials: D
authors.lastname: Pellerin
authors.forename: Aurélia
authors.initials: A
authors.lastname: Lamar
authors.forename: Alain
authors.initials: A
authors.lastname: Beauchet
authors.forename: Rami
authors.initials: R
authors.lastname: El Mahmoud
authors.forename: Rémy
authors.initials: R
authors.lastname: Pillière
authors.forename: William J
authors.initials: WJ
authors.lastname: McKenna
authors.forename: Olivier
authors.initials: O
authors.lastname: Dubourg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003287:Contrast Media; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000503:physiopathology; D003326:Coronary Circulation; D004452:Echocardiography; D005260:Female; D006801:Humans; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D015588:Observer Variation; D010743:Phospholipids; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013459:Sulfur Hexafluoride; D013599:Systole; D054549:Takotsubo Cardiomyopathy / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016277:Ventricular Function, Left
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride