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Multimodality imaging in takotsubo syndrome: a joint consensus document of the European Association of Cardiovascular Imaging (EACVI) and the Japanese Society of Echocardiography (JSE).

  • Citro R Cardiothoracic Vascular Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy.
  • Okura H Department of Cardiology, Gifu University Graduate School of Medicine, Gifu, Japan.
  • Ghadri JR Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.
  • Izumi C Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
  • Meimoun P Department of Cardiology and Intensive Care, Centre Hospitalier de Compiegne, Compiegne, France.
  • Izumo M Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.
  • Dawson D Department of Cardiology, Aberdeen Cardiovascular and Diabetes Centre, Aberdeen Royal Infirmary and University of Aberdeen, Aberdeen, Scotland, UK.
  • Kaji S Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
  • Eitel I Department of Cardiology, University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany.
  • Kagiyama N Department of Digital Health and Telemedicine R&D, Juntendo University and Department of Cardiovascular Medicine, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo City, Tokyo, 113-8421, Japan.
  • Kobayashi Y Department of Cardiovascular Institute, Stanford University, Stanford, CA, USA.
  • Templin C Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.
  • Delgado V Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
  • Nakatani S Saiseikai Senri Hospital, Suita, Osaka, Japan.
  • Popescu BA Department of Cardiology, University of Medicine and Pharmacy "Carol Davila," Euroecolab, Bucharest, Romania.
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  • 2020-08-29
Published in:
  • European heart journal cardiovascular Imaging. - 2020
multimodality imaging
Takotsubo syndrome
cardiac magnetic resonance
echocardiography
stress cardiomyopathy
English Takotsubo syndrome (TTS) is a complex and still poorly recognized heart disease with a wide spectrum of possible clinical presentations. Despite its reversibility, it is associated with serious adverse in-hospital events and high complication rates during follow-up. Multimodality imaging is helpful for establishing the diagnosis, guiding therapy, and stratifying prognosis of TTS patients in both the acute and post-acute phase. Echocardiography plays a key role, particularly in the acute care setting, allowing for the assessment of left ventricular (LV) systolic and diastolic function and the identification of the typical apical-midventricular ballooning pattern, as well as the circumferential pattern of wall motion abnormalities. It is also useful in the early detection of complications (i.e. LV outflow tract obstruction, mitral regurgitation, right ventricular involvement, LV thrombi, and pericardial effusion) and monitoring of systolic function recovery. Left ventriculography allows the evaluation of LV function and morphology, identifying the typical TTS patterns when echocardiography is not available or wall motion abnormalities cannot be properly assessed with ultrasound. Cardiac magnetic resonance provides a more comprehensive depiction of cardiac morphology and function and tissue characterization and offers additional value to other imaging modalities for differential diagnosis (myocardial infarction and myocarditis). Coronary computed tomography angiography has a substantial role in the diagnostic workup of patients with acute chest pain and a doubtful TTS diagnosis to rule out other medical conditions. It can be considered as a non-invasive appropriate alternative to coronary angiography in several clinical scenarios. Although the role of nuclear imaging in TTS has not yet been well established, the combination of perfusion and metabolic imaging may provide useful information on myocardial function in both the acute and post-acute phase.
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  • English
Open access status
bronze
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Persistent URL
https://sonar.ch/global/documents/197302
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