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Case Reports
. 2013;40(1):56-9.

Inverted Takotsubo cardiomyopathy and the fundamental diagnostic role of echocardiography

Arantza Manzanal  1 , Lara Ruiz, Jose Madrazo, Majesh Makan, Julio Perez
Affiliations
Case Reports

Inverted Takotsubo cardiomyopathy and the fundamental diagnostic role of echocardiography

Arantza Manzanal et al. Tex Heart Inst J. 2013.

Abstract

Takotsubo cardiomyopathy is characterized by the development of transient focal wall-motion abnormalities that involve the apical and midventricular segments, in the absence of obstructive coronary artery disease. A variant, inverted takotsubo cardiomyopathy, was described in 2010. We report 3 cases in which each patient's transthoracic echocardiogram revealed the characteristic basal and midventricular segmental akinesis of this variant. This pattern is not associated with coronary artery distribution, and it therefore can be differentiated from coronary artery disease with the use of echocardiography, by evaluating the distribution and temporal changes of akinetic areas.

Keywords: Cardiomyopathies/diagnosis/physiopathology; echocardiography; takotsubo cardiomyopathy/diagnosis; ventricular dysfunction, left/diagnosis.

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Figures

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Fig. 1 Patient 1. Transthoracic echocardiogram (4-chamber view) during A) systole and B) diastole shows basal and midventricular segmental hypokinesis but preserved apical segmental function during systole. Real-time motion image is available at www.texasheart.org/journal.
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Fig. 2 Patient 2. Transthoracic echocardiogram in A) systole and B) diastole shows severe midventricular and basal akinesis and apical hyperkinesis. Real-time motion image is available at www.texasheart.org/journal.
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Fig. 3 Patient 3. Transthoracic echocardiogram in A) systole and B) diastole shows severe left ventricular dysfunction and wall-motion abnormalities typical of inverted takotsubo cardiomyopathy. Real-time motion image is available at www.texasheart.org/journal.
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Fig. 4 Patient 3. Global longitudinal peak systolic strain (GLPS) shows normal apical strain and reduced strain in the mid and basal segments. A2C = apical 2-chamber; A4C = apical 4-chamber; ANT = anterior; ANT_SEPT = anteroseptal; AVC_AUTO = automatic video-level control; Avg = average; HR_ApLAX = heart rate–apical long-axis; INF = inferior; LAT = lateral; POST = posterior; SEPT = septal
See this image and copyright information in PMC

Comment in

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