Early prediction of ventricular recovery in Takotsubo syndrome using stress and contrast echocardiography.

BACKGROUND: Takotsubo syndrome is a primary, stress-provoked acquired cardiomyopathy mimicking acute myocardial infarction. Because of the less severe prognosis of takotsubo patients, a reliable method of predicting complete functional recovery has great practical value. CASE REPORT: A case of takotsubo syndrome is reported in a 59-year-old Caucasian woman in whom early echocardiographic imaging demonstrated normal myocardial perfusion and contractile reserve predictive of complete functional recovery. The patient was admitted with symptoms of acute coronary syndrome triggered by severe stress. Coronary angiography revealed no stenosis, whereas echocardiography revealed wall motion abnormalities of the left ventricular apex with an ejection fraction of 30%. Using low-dose dobutamine stress echocardiography and myocardial contrast echocardiography, the preliminary diagnosis of takotsubo cardiomyopathy was confirmed and a good prognosis regarding the recovery of wall motion abnormalities was predicted. After 30 days, echocardiography revealed fully restored ventricular function and a 270-day follow-up was uneventful.
CONCLUSIONS: Microcirculation assessment using myocardial contrast echocardiography as well as early contractile reserve in a low-dose dobutamine echocardiographic test might be useful in the prediction of functional recovery in suspected takotsubo syndrome.