“5-key points”
- 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.
- The degree of reduction in LV peak systolic strain of the affected regions are often in the same degree of magnitude from those observed in patients with coronary artery disease
- Post systolic shortening is much more pronounced (and a typical feature) in the affected regions compared to patients with ischemia/infarction
- LV twist mechanics is significantly impaired in patients with TTC mainly due to a severe reduction in apical function and is entirely reversible.
- Case report indicate that strain values and patterns completely recover during follow up.
Clinical examples:
Three forms of TT-CMP are presented
References:
- Mansencal N(1), Abbou N, Pillière R, El Mahmoud R, Farcot JC, Dubourg O. Usefulness of two-dimensional speckle tracking echocardiography for assessment of Tako-Tsubo cardiomyopathy. Am J Cardiol. 2009 Apr 1;103(7):1020-4.
- Park SM(1), Prasad A, Rihal C, Bell MR, Oh JK. Left ventricular systolic and diastolic function in patients with apicalballooning syndrome compared with patients with acute anterior ST-segmentelevation myocardial infarction: a functional paradox. Mayo Clin Proc. 2009 Jun;84(6):514-21.
- Meimoun P(1), Passos P, Benali T, Boulanger J, Elmkies F, Zemir H, Clerc J,Luycx-Bore A. Assessment of left ventricular twist mechanics in Tako-tsubo cardiomyopathy by two-dimensional speckle-tracking echocardiography. Eur J Echocardiogr. 2011 Dec;12(12):931-9.
- Citro R(1), Lyon AR(2), Meimoun P(3), Omerovic E(4), Redfors B(4), Buck T(5), Lerakis S(6), Parodi G(7), Silverio A(8), Eitel I(9), Schneider B(10), Prasad A(11), Bossone E(8). Standard and advanced echocardiography in takotsubo (stress) cardiomyopathy: clinical and prognostic implications. J Am Soc Echocardiogr. 2015 Jan;28(1):57-74.
- Sosa S(1), Banchs J(2). Early recognition of apical ballooning syndrome by global longitudinal strain using speckle tracking imaging–the evil eye pattern, a case series. Echocardiography. 2015 Jul;32(7):1184-92.
- Cinotti R, Piriou N, Launey Y, Le Tourneau T, Lamer M, Delater A, Trochu JN, Brisard L, Lakhal K, Bourcier R, Desal H, Seguin P, Mallédant Y, Blanloeil Y, Feuillet F, Asehnoune K, Rozec B. Speckle tracking analysis allows sensitive detection of stress cardiomyopathy in severe aneurysmal subarachnoid hemorrhage patients. Intensive Care Med. 2016 Feb;42(2):173-82.