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KEY FACTS
Terminology
Imaging
Clinical Issues
TERMINOLOGY
Synonyms
Stress-induced cardiomyopathy
Apical ballooning syndrome
Definitions
Reversible dysfunction of left ventricle (LV) in absence of significant coronary artery stenosis
Classically described following periods of severe emotional or physical stress
In recent prospective multicenter study, stressful trigger was identified in ~ 70% of patients
Often accompanied by acute chest pain, ischemic ST segment abnormalities, and elevation of cardiac biomarkers
IMAGING
General Features
Imaging Recommendations
Nuclear Medicine Findings
CT Findings
MR Findings
Echocardiographic Findings
Angiographic Findings
Image-Guided Biopsy
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Citro R et al: Long-term outcome in patients with Takotsubo syndrome presenting with severely reduced left ventricular ejection fraction. Eur J Heart Fail. ePub, 2019
Templin C et al: Altered limbic and autonomic processing supports brain-heart axis in Takotsubo syndrome. Eur Heart J. ePub, 2019
Scally C et al: Persistent long-term structural, functional, and metabolic changes after stress-induced (Takotsubo) cardiomyopathy. Circulation. 137(10):1039-48, 2018
Abbas A et al: Cardiac magnetic resonance assessment of takotsubo cardiomyopathy. Clin Radiol. 71(1):e110-9, 2016
Plácido R et al: The role of cardiovascular magnetic resonance in takotsubo syndrome. J Cardiovasc Magn Reson. 18(1):68, 2016
Rajiah P et al: Update on the role of cardiac magnetic resonance in acquired nonischemic cardiomyopathies. J Thorac Imaging. 31(6):348-66, 2016
Garg P et al: Important role of myocardial tissue characterization by cardiac MRI in diagnosing Takotsubo syndrome. Nat Rev Cardiol. 12(11):669, 2015
Kohan AA et al: Usefulness of MRI in takotsubo cardiomyopathy: a review of the literature. Cardiovasc Diagn Ther. 4(2):138-46, 2014
Nakamori S et al: Prevalence and signal characteristics of late gadolinium enhancement on contrast-enhanced magnetic resonance imaging in patients with takotsubo cardiomyopathy. Circ J. 76(4):914-21, 2012
Eitel I et al: Clinical characteristics and cardiovascular magnetic resonance findings in stress (takotsubo) cardiomyopathy. JAMA. 306(3):277-86, 2011
King A: Cardiomyopathies: CMR sheds new light on the clinical profile of stress cardiomyopathy. Nat Rev Cardiol. 8(9):480, 2011
Naruse Y et al: The clinical impact of late gadolinium enhancement in Takotsubo cardiomyopathy: serial analysis of cardiovascular magnetic resonance images. J Cardiovasc Magn Reson. 13:67, 2011
Bellera MN et al: Magnetic resonance reveals long-term sequelae of apical ballooning syndrome. Int J Cardiol. 139(1):25-31, 2010
Hurst RT et al: Takotsubo cardiomyopathy: a unique cardiomyopathy with variable ventricular morphology. JACC Cardiovasc Imaging. 3(6):641-9, 2010
Sharkey SW et al: Natural history and expansive clinical profile of stress (tako-tsubo) cardiomyopathy. J Am Coll Cardiol. 55(4):333-41, 2010
Celik T et al: Stress-induced (Takotsubo) cardiomyopathy: a transient disorder. Int J Cardiol. 131(2):265-6, 2009
Kurisu S et al: Prevalence of incidental coronary artery disease in tako-tsubo cardiomyopathy. Coron Artery Dis. 20(3):214-8, 2009
Rolf A et al: Immunohistological basis of the late gadolinium enhancement phenomenon in tako-tsubo cardiomyopathy. Eur Heart J. 30(13):1635-42, 2009
Dorfman TA et al: An unusual manifestation of Takotsubo cardiomyopathy. Clin Cardiol. 31(5):194-200, 2008
Arora S: Autonomic imbalance in patients with takotsubo cardiomyopathy: cause or association? QJM. 100(9):593-4; author reply 594-6, 2007
Cocco G et al: Stress-induced cardiomyopathy: a review. Eur J Intern Med. 18(5):369-79, 2007
Haghi D et al: Guidelines for diagnosis of takotsubo (ampulla) cardiomyopathy. Circ J. 71(10):1664; author reply 1665, 2007
Kawai S: Typical and atypical forms of takotsubo (ampulla) cardiomyopathy. Circ J. 71(10):1665, 2007
Kimura K et al: Images in cardiovascular medicine. Rapid formation of left ventricular giant thrombus with Takotsubo cardiomyopathy. Circulation. 115(23):e620-1, 2007
Nanda S et al: Takotsubo cardiomyopathy--a new variant and widening disease spectrum. Int J Cardiol. 120(2):e34-6, 2007
Pilgrim TM et al: Takotsubo cardiomyopathy or transient left ventricular apical ballooning syndrome: A systematic review. Int J Cardiol. 2007
Gianni M et al: Apical ballooning syndrome or takotsubo cardiomyopathy: a systematic review. Eur Heart J. 27(13):1523-9, 2006
Iqbal MB et al: Stress, emotion and the heart: tako-tsubo cardiomyopathy. Postgrad Med J. 82(974):e29, 2006
Bybee KA et al: Systematic review: transient left ventricular apical ballooning: a syndrome that mimics ST-segment elevation myocardial infarction. Ann Intern Med. 141(11):858-65, 2004
Ito T et al: Development of pulmonary neuroendocrine cells of fetal hamster in explant culture. Lab Invest. 77(5):449-57, 1997
Related Anatomy
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Clinical Issues
TERMINOLOGY
Synonyms
Stress-induced cardiomyopathy
Apical ballooning syndrome
Definitions
Reversible dysfunction of left ventricle (LV) in absence of significant coronary artery stenosis
Classically described following periods of severe emotional or physical stress
In recent prospective multicenter study, stressful trigger was identified in ~ 70% of patients
Often accompanied by acute chest pain, ischemic ST segment abnormalities, and elevation of cardiac biomarkers
IMAGING
General Features
Imaging Recommendations
Nuclear Medicine Findings
CT Findings
MR Findings
Echocardiographic Findings
Angiographic Findings
Image-Guided Biopsy
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Citro R et al: Long-term outcome in patients with Takotsubo syndrome presenting with severely reduced left ventricular ejection fraction. Eur J Heart Fail. ePub, 2019
Templin C et al: Altered limbic and autonomic processing supports brain-heart axis in Takotsubo syndrome. Eur Heart J. ePub, 2019
Scally C et al: Persistent long-term structural, functional, and metabolic changes after stress-induced (Takotsubo) cardiomyopathy. Circulation. 137(10):1039-48, 2018
Abbas A et al: Cardiac magnetic resonance assessment of takotsubo cardiomyopathy. Clin Radiol. 71(1):e110-9, 2016
Plácido R et al: The role of cardiovascular magnetic resonance in takotsubo syndrome. J Cardiovasc Magn Reson. 18(1):68, 2016
Rajiah P et al: Update on the role of cardiac magnetic resonance in acquired nonischemic cardiomyopathies. J Thorac Imaging. 31(6):348-66, 2016
Garg P et al: Important role of myocardial tissue characterization by cardiac MRI in diagnosing Takotsubo syndrome. Nat Rev Cardiol. 12(11):669, 2015
Kohan AA et al: Usefulness of MRI in takotsubo cardiomyopathy: a review of the literature. Cardiovasc Diagn Ther. 4(2):138-46, 2014
Nakamori S et al: Prevalence and signal characteristics of late gadolinium enhancement on contrast-enhanced magnetic resonance imaging in patients with takotsubo cardiomyopathy. Circ J. 76(4):914-21, 2012
Eitel I et al: Clinical characteristics and cardiovascular magnetic resonance findings in stress (takotsubo) cardiomyopathy. JAMA. 306(3):277-86, 2011
King A: Cardiomyopathies: CMR sheds new light on the clinical profile of stress cardiomyopathy. Nat Rev Cardiol. 8(9):480, 2011
Naruse Y et al: The clinical impact of late gadolinium enhancement in Takotsubo cardiomyopathy: serial analysis of cardiovascular magnetic resonance images. J Cardiovasc Magn Reson. 13:67, 2011
Bellera MN et al: Magnetic resonance reveals long-term sequelae of apical ballooning syndrome. Int J Cardiol. 139(1):25-31, 2010
Hurst RT et al: Takotsubo cardiomyopathy: a unique cardiomyopathy with variable ventricular morphology. JACC Cardiovasc Imaging. 3(6):641-9, 2010
Sharkey SW et al: Natural history and expansive clinical profile of stress (tako-tsubo) cardiomyopathy. J Am Coll Cardiol. 55(4):333-41, 2010
Celik T et al: Stress-induced (Takotsubo) cardiomyopathy: a transient disorder. Int J Cardiol. 131(2):265-6, 2009
Kurisu S et al: Prevalence of incidental coronary artery disease in tako-tsubo cardiomyopathy. Coron Artery Dis. 20(3):214-8, 2009
Rolf A et al: Immunohistological basis of the late gadolinium enhancement phenomenon in tako-tsubo cardiomyopathy. Eur Heart J. 30(13):1635-42, 2009
Dorfman TA et al: An unusual manifestation of Takotsubo cardiomyopathy. Clin Cardiol. 31(5):194-200, 2008
Arora S: Autonomic imbalance in patients with takotsubo cardiomyopathy: cause or association? QJM. 100(9):593-4; author reply 594-6, 2007
Cocco G et al: Stress-induced cardiomyopathy: a review. Eur J Intern Med. 18(5):369-79, 2007
Haghi D et al: Guidelines for diagnosis of takotsubo (ampulla) cardiomyopathy. Circ J. 71(10):1664; author reply 1665, 2007
Kawai S: Typical and atypical forms of takotsubo (ampulla) cardiomyopathy. Circ J. 71(10):1665, 2007
Kimura K et al: Images in cardiovascular medicine. Rapid formation of left ventricular giant thrombus with Takotsubo cardiomyopathy. Circulation. 115(23):e620-1, 2007
Nanda S et al: Takotsubo cardiomyopathy--a new variant and widening disease spectrum. Int J Cardiol. 120(2):e34-6, 2007
Pilgrim TM et al: Takotsubo cardiomyopathy or transient left ventricular apical ballooning syndrome: A systematic review. Int J Cardiol. 2007
Gianni M et al: Apical ballooning syndrome or takotsubo cardiomyopathy: a systematic review. Eur Heart J. 27(13):1523-9, 2006
Iqbal MB et al: Stress, emotion and the heart: tako-tsubo cardiomyopathy. Postgrad Med J. 82(974):e29, 2006
Bybee KA et al: Systematic review: transient left ventricular apical ballooning: a syndrome that mimics ST-segment elevation myocardial infarction. Ann Intern Med. 141(11):858-65, 2004
Ito T et al: Development of pulmonary neuroendocrine cells of fetal hamster in explant culture. Lab Invest. 77(5):449-57, 1997
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