Multimodality imaging in takotsubo syndrome: a joint consensus document of the European Association of Cardiovascular Im
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SPECIAL ARTICLE
Multimodality imaging in takotsubo syndrome: a joint consensus document of the European Association of Cardiovascular Imaging (EACVI) and the Japanese Society of Echocardiography (JSE) Rodolfo Citro (Chair)1 · Hiroyuki Okura (Co‑Chair)2 · Jelena R Ghadri3 · Chisato Izumi4 · Patrick Meimoun5 · Masaki Izumo6 · Dana Dawson7 · Shuichiro Kaji8 · Ingo Eitel9,10 · Nobuyuki Kagiyama11 · Yukari Kobayashi12 · Christian Templin3 · Victoria Delgado13 · Satoshi Nakatani14 · Bogdan A Popescu15,16 Received: 4 May 2020 / Accepted: 5 May 2020 © The Author(s) 2020
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-acutephase. Keywords Takotsubo syndrome · Stress cardiomyopathy · Echocardiography · Cardiac magnetic resonance · Multimodality imaging
This document was reviewed by members of the 2018–2020 EACVI Scientific Documents Committee: Philippe Bertrand, Erwan Donal, Marc Dweck, Maurizio Galderisi, Kristina H. Haugaa, Leyla Elif Sade, Ivan Stankovic, by the chair of the 2018–2020 EACVI Scientific Documents Committee: Bernard Cosyns, by the 2018–2020 EACVI President: Thor Edvardsen. This article is co-published in the jou
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