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European Journal of Echocardiography Advance Access originally published online on June 20, 2008
European Journal of Echocardiography 2008 9(6):849-854; doi:10.1093/ejechocard/jen192
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Takotsubo cardiomyopathy: pathogenetic insights and myocardial perfusion kinetics using myocardial contrast echocardiography

Luis Afonso*, Khaled Bachour, Khaled Awad and Greg Sandidge

Division of Cardiology, 3990 John R, 8 Brush, Harper University Hospital, Wayne State University, Detroit Medical Center, Detroit, MI 48201, USA

Received 19 March 2008; accepted after revision 30 May 2008; online publish-ahead-of-print 20 June 2008.

* Corresponding author. Tel: +1 313 745 2620; fax: +1 313 993 8627. E-mail address: lafonso{at}med.wayne.edu


  Abstract

Transient apical ballooning syndrome or Takotsubo cardiomyopathy (TC) is a novel acute cardiac syndrome, characterized by regional systolic dysfunction involving the apex and mid-ventricular segments, with hyperkinesis of the basal segments. Mid-ventricular ballooning cardiomyopathy (MVBC) is a recently recognized variant of TC. Both disorders share the same precipitating factors, clinical features and course; however, unlike TC, MVBC is characterized by ballooning and akinesis of the mid-ventricular segments with hypercontractility of the basal and apical segments. While the precise pathogenetic mechanism of this disorder remains elusive, microvascular dysfunction from excessive catecholamine release has been implicated. We report findings on regional contractile dysfunction (strain imaging), myocardial blood flow (semi-quantitative), and perfusion kinetics using myocardial contrast echocardiography in a series of three illustrative cases of TC.

Keywords: Takotsubo cardiomyopathy; Myocardial contrast echocardiography; Myocardial perfusion; Apical ballooning syndrome; Microvascular


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