title: Standard and advanced echocardiography in takotsubo (stress) cardiomyopathy: clinical and prognostic implications.
abstract: Echocardiography is frequently the initial noninvasive imaging modality used to assess patients with takotsubo cardiomyopathy (TTC). Standard transthoracic echocardiography can provide, even in the acute care setting, useful information about left ventricular (LV) morphology as well as regional and global systolic or diastolic function. It allows the differentiation of different LV morphologic patterns according to the localization of wall motion abnormalities. A "circumferential pattern" of LV myocardial dysfunction characterized by symmetric wall motion abnormalities involving the midventricular segments of the anterior, inferior, and lateral walls should be considered suggestive of TTC and included in the differential diagnosis of acute coronary syndromes. Moreover, advanced echocardiographic techniques, including speckle-tracking, myocardial contrast, and coronary flow studies, are providing mechanistic and pathophysiologic insights into this unique syndrome. Early identification of any potential complications (i.e., LV outflow tract obstruction, reversible moderate to severe mitral regurgitation, right ventricular involvement, thrombus formation, and cardiac rupture) are crucial for the management, risk stratification, and follow-up of patients with TTC. Because of the dynamic evolution of the syndrome, comprehensive serial echocardiographic examinations should be systematically performed. This review focuses on these aspects of imaging and the increasing understanding of the clinical and prognostic utility of echocardiography in TTC.
authors.affiliation: Heart Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona" Salerno, Italy. Electronic address: rodolfocitro@gmail.com.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Citro
authors.affiliation: NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom.
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Lyon
authors.affiliation: Cardiology Department and Intensive Care Unit, Compiègne Hospital, Compiègne, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Meimoun
authors.affiliation: Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Elmir
authors.initials: E
authors.lastname: Omerovic
authors.affiliation: Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Björn
authors.initials: B
authors.lastname: Redfors
authors.affiliation: Clinic of Cardiology, Klinikum Westfalen, Dortmund, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Buck
authors.affiliation: Division of Cardiology, Department of Medicine, Emory University School Medicine, Atlanta, Georgia.
authors.forename: Stamatios
authors.initials: S
authors.lastname: Lerakis
authors.affiliation: Division of Cardiology, Careggi University Hospital, Florence, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Parodi
authors.affiliation: Heart Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona" Salerno, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Silverio
authors.affiliation: University Heart Center of Luebeck, Medical Clinic II, Department of Cardiology, Angiology and Intensiv Care Medicine, Luebeck, Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Eitel
authors.affiliation: Medizinische Klinik II, Sana Kliniken Lübeck, Lübeck, Germany.
authors.forename: Birke
authors.initials: B
authors.lastname: Schneider
authors.affiliation: Cardiovascular Sciences Research Centre, St George's, University of London, London, United Kingdom.
authors.forename: Abhiram
authors.initials: A
authors.lastname: Prasad
authors.affiliation: Heart Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona" Salerno, Italy.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bossone
mesh_terms: D004452:Echocardiography / Q000379:methods* / Q000592:standards*; D005080:Exercise Test / Q000379:methods / Q000592:standards*; D006801:Humans; D007089:Image Enhancement / Q000379:methods / Q000592:standards*; D011379:Prognosis; D054549:Takotsubo Cardiomyopathy / Q000000981:diagnostic imaging*; D014481:United States
keywords: Apical ballooning syndrome; Echocardiography; Heart failure; Stress cardiomyopathy; Takotsubo cardiomyopathy