Standard and advanced echocardiography in takotsubo (stress) cardiomyopathy: Clinical and prognostic implications

Rodolfo Citro, Alexander R. Lyon, Patrick Meimoun, Elmir Omerovic, Bjorn Redfors, Thomas Buck, Stamatios Lerakis, Guido Parodi, Angelo Silverio, Ingo Eitel, Birke Schneider, Abhiram Prasad, Eduardo Bossone

Research output: Contribution to journalReview articlepeer-review

64 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)57-74
Number of pages18
JournalJournal of the American Society of Echocardiography
Issue number1
StatePublished - 2015


  • Apical ballooning syndrome
  • Echocardiography
  • Heart failure
  • Stress cardiomyopathy
  • Takotsubo cardiomyopathy

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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