State-of-the-Art Review ArticleStandard and Advanced Echocardiography in Takotsubo (Stress) Cardiomyopathy: Clinical and Prognostic Implications
Section snippets
LV Systolic Function
In the acute phase, transthoracic echocardiography (TTE) usually identifies the characteristic LV morphology associated with TTC. Standard TTE allows the detection of the different LV morphologic patterns according to the localization of wall motion abnormalities (WMAs).14, 15, 16 In the majority of cases, WMA typically involve the apical and midventricular segments, which appear akinetic or dyskinetic (defined as “apical ballooning”) in contrast to the basal segments, which are often
Myocardial Deformation Imaging
The profound transient LV dysfunction seen in TTC disturbs LV mechanics as well (Figure 6, Figure 7, Figure 8). Most data on myocardial deformation imaging in TTC are provided by two-dimensional strain with speckle-tracking echocardiography,30, 51, 52, 53, 54, 55 which allows the assessment of multidirectional LV deformation due to the complex myocardial architecture (longitudinal and circumferential shortening, radial thickening, and twisting).56 During the acute phase, there is a
Diagnostic Algorithm
Echocardiography may play a key role in the diagnostic workup of patients with TTC (Figure 13). In patients presenting with chest pain and/or dyspnea and ST-segment elevation on electrocardiography, emergency coronary angiography to exclude coronary occlusion or the presence of culprit lesions and left ventriculography are highly recommended. Conversely, in selected patients predisposed to develop TTC (postmenopausal women, those with trigger events) with no ST-segment elevation on
Conclusions
Echocardiography is generally the most practical diagnostic imaging technique for the majority of patients suspected of having TTC. Because of its dynamic and unique nature, comprehensive serial examinations should be systematically performed. Standard echocardiography can identify important distinctive features of TTC (Table 3). Advanced echocardiographic techniques, including speckle-tracking, myocardial contrast, and coronary flow studies, are providing further mechanistic and
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2021, Trends in Cardiovascular MedicineCitation Excerpt :In such circumstances, close monitoring is crucial to promptly identify patients requiring pharmacological or mechanical inotropic support, anticoagulation or other therapies. Moreover, in patients with extensive apical akinesis resembling apical ballooning and without evidence of obstructive CAD or myocardial LIE, TTS should be suspected (Fig. 3) [36–38]. Patients with COVID-19 and dyspnea or hypoxia are most commonly affected by pneumonia.