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

2020 ◽  
Vol 21 (11) ◽  
pp. 1184-1207 ◽  
Author(s):  
Rodolfo Citro ◽  
Hiroyuki Okura ◽  
Jelena R Ghadri ◽  
Chisato Izumi ◽  
Patrick Meimoun ◽  
...  
Keyword(s):  
Acute Phase ◽  
Wall Motion ◽  
Multimodality Imaging ◽  
Left Ventricular ◽  
Metabolic Imaging ◽  
Lv Function ◽  
Complication Rates ◽  
Takotsubo Syndrome ◽  
Clinical Scenarios ◽  
Wall Motion Abnormalities

Abstract 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.

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

2020 ◽  
Vol 18 (4) ◽  
pp. 199-224
Author(s):  
Rodolfo Citro ◽  
Hiroyuki Okura ◽  
Jelena R Ghadri ◽  
Chisato Izumi ◽  
Patrick Meimoun ◽  
...  
Keyword(s):  
Acute Phase ◽  
Wall Motion ◽  
Multimodality Imaging ◽  
Left Ventricular ◽  
Metabolic Imaging ◽  
Lv Function ◽  
Complication Rates ◽  
Takotsubo Syndrome ◽  
Clinical Scenarios ◽  
Wall Motion Abnormalities

AbstractTakotsubo 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.

scholarly journals Challenges in the diagnosis of peripartum cardiomyopathy: a case series

2021 ◽  
Vol 5 (2) ◽  
Author(s):  
Fabio Chirillo ◽  
Anna Baritussio ◽  
Umberto Cucchini ◽  
Ermanno Toniolli ◽  
Angela Polo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Multimodality Imaging ◽  
Systolic Dysfunction ◽  
Case Series ◽  
Left Ventricular ◽  
Peripartum Cardiomyopathy ◽  
Lv Function ◽  
Prognostic Information ◽  
Clinical Scenarios ◽  
Anterolateral Wall

Abstract Background Peripartum cardiomyopathy (PPCM) is usually characterized by overt heart failure, but other clinical scenarios are possible, sometimes making the diagnosis challenging. Case summary We report a case series of four patients with PPCM. The first patient presented with acute heart failure due to left ventricular (LV) systolic dysfunction. Following medical treatment, LV function recovered completely at 1 month. The second patient had systemic and pulmonary thromboembolism, secondary to severe biventricular dysfunction with biventricular thrombi. The third patient presented with myocardial infarction with non-obstructed coronary arteries and evidence of an aneurysm of the mid-anterolateral LV wall. The fourth patient, diagnosed with PPCM 11 years earlier, presented with sustained ventricular tachycardia. A repeat cardiac magnetic resonance, compared to the previous one performed 11 years earlier, showed an enlarged LV aneurysm in the mid-LV anterolateral wall with worsened global LV function. Discussion Peripartum cardiomyopathy may have different clinical presentations. Attentive clinical evaluation and multimodality imaging can provide precise diagnostic and prognostic information.

scholarly journals Echocardiographic assessment of left ventricular function in patients of acute myocardial infarction

2017 ◽  
Vol 4 (4) ◽  
pp. 926
Author(s):  
Anjali V. Shivpuje ◽  
Shrikant Page
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Wall Motion ◽  
Health Centre ◽  
Regional Wall Motion ◽  
Left Ventricular ◽  
Lv Function ◽  
Regional Wall ◽  
Wall Motion Abnormalities ◽  
Echocardiographic Assessment

Background:2D Echo can evaluate LV anatomy, function and diagnose post AMI complications in early stages, thus help in management and determining the prognosis. The present study was undertaken to evaluate LV function in patient following AMI and also to find out the incidence of various echocardiographically detectable complications of following AMI.Methods: The present study was conducted on patients visiting our tertiary health centre during study duration. 50 patients were included in the study. Patients with prior history of acute myocardial infarction, pericarditis and early repolarisation syndrome, and primary myocardial disease diagnosed by serum enzyme levels were not included in the study. Patients were classified as per Killip classification and 2D echo study was performed in all patients.Results: Maximum incidence of AMI was found in 51-60 years of age, with male predominance (64%). Anterior wall AMI (58%) was more common. 94% of patients had wall motion abnormalities. Incidence of LV thrombus was found to be 24%. In present study, as the extent and severity of wall motion abnormalities increased, the incidence of LV thrombus also increased. Thus, 2DE study of LV regional wall motion can predict the incidence of LV thrombus.Conclusions: The echocardiographic assessment of LV function in patients of AMI is important as, it detects the regional wall motion abnormality, LVEF and also the complications like LV thrombus, pericardial effusion and LV aneurysm. These observations are of great value in the management of AMI.  

scholarly journals ECG changes and wall motion abnormalities in the acute phase of takotsubo syndrome

2013 ◽  
Vol 34 (suppl 1) ◽  
pp. P1197-P1197
Author(s):  
V. Weihs ◽  
P. Sziostronek ◽  
B. Eber ◽  
W. Weihs ◽  
F. Leisch ◽  
...  
Keyword(s):  
Acute Phase ◽  
Wall Motion ◽  
Takotsubo Syndrome ◽  
Ecg Changes ◽  
Wall Motion Abnormalities

scholarly journals P1497 Atypical variant of takotsubo cardiomyopathy due to an unusual non-emotional trigger

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
O M Perez Fernandez ◽  
S A Higuera Leal ◽  
C P Jaimes ◽  
L M Contreras ◽  
J Gelves ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Emotional Stress ◽  
Takotsubo Cardiomyopathy ◽  
Wall Motion ◽  
Multimodality Imaging ◽  
Regional Wall Motion ◽  
Left Ventricular ◽  
Regional Wall ◽  
Regional Wall Motion Abnormalities ◽  
Wall Motion Abnormalities

Abstract Background Takotsubo Cardiomyopathy (TCM) is characterized by left ventricular regional wall motion abnormalities, classically described as apical ballooning (atypical features such as midventricular, basal, or focal wall motion abnormalities also have been described) and triggered by emotional or physical stress. In this case, TCM was triggered by non-emotional stress, and eventually an unusual definite diagnosis was ascertained based on pathological specimen. Case report a 63-year-old woman presented to the emergency room complaining of 5 days of epigastric pain, nausea and emesis followed by chest tightness, dyspnea and diaphoresis. Physical examination was noticeable for abdominal pain with positive Murphy´s sign. ECG showed normal sinus rhythm, with T-wave inversion in DIII and aVF, and elevated troponin I. She also had leukocytosis and neutrophilia with normal liver function tests. Abdominal ultrasound showed a distended gallbladder with gallstones, without definitive evidence of cholecystitis. Accordingly, she was admitted to the Coronary Care Unit with suspected Non-ST elevation myocardial infarction. Trans-thoracic echocardiogram (TTE) showed akinesia of all mid left ventricular segments with moderate systolic dysfunction -LVEF: 40%- (Figure 1A) suspicious for atypical TCM without a clear and identifiable emotional stress. Coronary angiography was negative for coronary stenosis and cardiac magnetic resonance (CMR) showed mid anterior and anterolateral segments dyskinesia, as well as mid septal, inferior and inferolateral segments akinesia (Figures 1B), with myocardial edema and no late gadolinium enhancement (Figure 1C), findings suggestive of TCM. Concomitant abdominal MRI demonstrated gallbladder distention, wall thickeningandedema, gallstones and peri-vesicular fat edema (Figure 1D). Consequently, an infrequent type 2 (mid-ventricular) TCM, triggered by abdominal pain and inflammatory response due to acute cholecystitis, was diagnosed. Surgery was differed until full recovery of left ventricular function. One month later, after a full course of antibiotics and a new TTE showing no regional wall motion abnormalities (Figure 1E), a cholecystectomy was performed. Surprisingly, pathology revealed acute on chronic cholecystitis with eosinophilic infiltration, findings compatible with subacute cholecystitis (surgery performed 4 weeks after onset of symptoms). Currently, the patient is followed by Gastro-enterology for additional work-up. Conclusion We highlight the importance of multimodality imaging during diagnostic approach of atypical TCM. In this case, TTE findings in addition to a normal coronary angiogram, resulted in clinical suspicion of mid-ventricular TCM (present in 15% of cases) which was confirmed by CMR during the index event, followed by a normal TTE 4 weeks later. Cholecystitis is one of the multiple physical stressors, in addition to emotional triggers, causing TCM. Abstract P1497 Figure.

scholarly journals Takotsubo Syndrome Versus Myocardial Infarction: what is the role of Echocardiography?

2019 ◽  
Vol 2 (2) ◽  
pp. 01-07
Author(s):  
Raquel Menezes Fernandes ◽  
Hugo Costa ◽  
Teresa Mota ◽  
João Bispo ◽  
Pedro Azevedo ◽  
...  
Keyword(s):  
Wall Motion ◽  
Complete Recovery ◽  
Left Ventricular ◽  
Single Coronary Artery ◽  
Takotsubo Syndrome ◽  
Early Evaluation ◽  
Coronary Syndrome ◽  
Wall Motion Abnormalities ◽  
Left Ventricle Dysfunction

Reversible left ventricle dysfunction is a key feature of Takotsubo syndrome (TTS), but in the acute phase it can mimic an acute coronary syndrome, making this differentiation a significant challenge. Echocardiography is widely used in the early evaluation of these patients, and advanced imaging tools have highlighted the differences between both syndromes. The symmetrical pattern of left ventricular dysfunction, extending beyond the territory of a single coronary artery, associated with a less severe diastolic dysfunction, right ventricle involvement and a typical complete recovery of wall-motion abnormalities points towards the diagnosis of TTS. Despite all the imaging advances made so far, evaluation of coronary anatomy remains mandatory in these patients.

Left and Right Ventricular Wall Motion Abnormalities In Thalassemia Major Patients

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2255-2255
Author(s):  
Antonella Meloni ◽  
Gaetano Giuffrida ◽  
Cristina Paci ◽  
Leonardo Sardella ◽  
Alessandra Quota ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Iron Overload ◽  
Right Ventricular ◽  
Myocardial Fibrosis ◽  
Wall Motion ◽  
Thalassemia Major ◽  
Left Ventricular ◽  
Lv Function ◽  
Myocardial Iron ◽  
Wall Motion Abnormalities

Abstract Introduction Left ventricular (LV) and right ventricular (RV) wall motion abnormalities can be detected through a qualitative analysis of cine magnetic resonance (MR) images. Moreover, MR is the gold standard technique for the evaluation of myocardial iron overload (MIO), biventricular global systolic function and myocardial fibrosis. We investigated the relationships between LV movement abnormalities and MIO, LV function and myocardial fibrosis as well as between RV motion and function in thalassemia major (TM) patients. Methods CMR was performed in 1092 TM patients (537 male; 30.6±8.5 years) enrolled in the Myocardial Iron Overload in Thalassemia Network. Cine images were acquired to evaluate wall motion and to quantify biventricular volumes and ejection fraction (EF). For MIO assessment, a T2* multislice approach was used. To detect myocardial fibrosis, late gadolinium enhanced (LGE) images were acquired. For the LV the 16-segment model of the AHA/ACC was taken into account during image analysis: wall motion, T2* value and presence/absence of enhancing area were evaluated for each segment. Results Abnormal motion of LV was found in 66 (6%) patients (60 hypokinetic and 6 dyskinetic). Table 1 shows the comparison between TM patients with normal and abnormal LV motion. Patients with abnormal LV motion were older and had significantly lower global T2* value and significantly higher number of segments with T2*<20 ms. Left volumes and mass indexed by body surface area were significantly higher in patients with abnormal LV motion while the EF was significantly lower. LGE areas were detected in 196 patients (18%) and were predominantly located in the mid-ventricular septum. There was a significant correlation between LGE and abnormal LV motion. Abnormal motion of the RV was found in 35 (3.2%) patients (29 hypokinetic, 5 dyskinetic and 1 akynetic). Table 2 shows the comparison between TM patients with normal and abnormal RV motion. Patients with abnormal RV motion were older and they were more frequently males. Right volumes were significantly higher in patients with abnormal RV motion while the EF was significantly lower. Abnormal LV motion was not correlated with abnormal RV motion. Seventeen patients showed movement abnormalities in both ventricles. Conclusions Movement abnormalities in the left ventricle were not really frequent in TM patients but were associated with age, MIO, LV dilation and dysfunction, and myocardial fibrosis. Movement abnormalities in the right ventricle were less frequent compared to the left ventricle, but were associated with age, sex , RV dilation and dysfunction. Disclosures: No relevant conflicts of interest to declare.

Reversible exercise-induced left ventricular dysfunction in symptomatic patients with previous Takotsubo syndrome: insights from stress echocardiography

2020 ◽  
Author(s):  
H Yakup Yakupoglu ◽  
Sahrai Saeed ◽  
Roxy Senior ◽  
A John Baksi ◽  
Alexander R Lyon ◽  
...  
Keyword(s):  
Wall Motion ◽  
Beta Blockers ◽  
Wall Stress ◽  
Left Ventricular ◽  
Lv Function ◽  
Exercise Echocardiography ◽  
Takotsubo Syndrome ◽  
Persistent Symptoms ◽  
Lv Volumes ◽  
Exercise Induced

Abstract Aims  Takotsubo syndrome (TTS) is usually associated with rapid and spontaneous recovery of left ventricular (LV) function. However, a proportion of patients may have persistent symptoms. This study aimed to determine the haemodynamic and LV contractile responses to exercise in these patients. Methods and results Thirty symptomatic TTS patients referred for exercise echocardiography, a median of 15 months following the index TTS episode, were matched with 30 controls with normal exercise echocardiography. Beta-blockers were withheld prior to the test. LV volumes, ejection fraction (EF) and wall motion score index (WMSI), were measured at rest and stress. The TTS cohort were Caucasian women with mean age of 64.6 ± 7.4 years and similar coronary risk factor profile and EF to controls. Resting systolic blood pressure (SBP), LV end-diastolic volume, wall stress, and right ventricular fractional area change were higher in TTS patients compared with controls. Stress echo data showed similar exercise time, peak heart rate, and peak SBP in TTS patients vs. controls, but TTS patients had higher LV volumes, lower exercise LVEF (70 ± 10% vs. 78 ± 7%; P = 0.001), ΔLVEF (4 ± 8% vs. 12 ± 5%; P &lt; 0.001), and WMSI (1.4 ± 0.4 vs. 1 ± 0; P &lt; 0.001) compared with controls. Twenty TTS patients had clear exercise-induced wall motion abnormalities, mainly involving the apex or more globally, with a mean ΔLVEF of 1% compared with 12% in controls. Among the other 10 TTS patients, the ΔLVEF was 10%. Conclusion Symptomatic patients with previous TTS have a blunted contractile response to exercise. The therapeutic and prognostic implications of these findings need further investigation.

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