Search Results (148)

Coronary flow reserve (CFR) is a fundamental physiological index defined as the ratio of maximal coronary blood flow during hyperemia to resting flow. It provides an integrated assessment of the entire coronary circulation, from epicardial arteries to the microvasculature. Non-invasive assessment, particularly with transthoracic Doppler echocardiography (TTDE), is valuable in clinical practice for evaluating the functional impact of moderate obstructive lesions and determining the status of coronary microcirculation. Impairment of coronary microcirculation, detected by reduced CFR, is present in diverse conditions such as Tako-Tsubo cardiomyopathy, cardiac syndrome X, hypertension, and slow coronary flow. CFR also serves as a non-invasive tool to examine the effects of various interventions. CFR can be assessed invasively using Doppler guidewire or thermodilution techniques and non-invasively using transthoracic Doppler echocardiography, PET, CMR, CT perfusion, and dynamic SPECT. Lower CFR is observed with advancing age, in females, and in individuals of African descent. An impaired CFR is a powerful, independent predictor of major adverse cardiovascular events (MACEs) across a wide spectrum of diseases, including stable obstructive coronary artery disease (CAD), ischemic syndromes with no obstructive coronary arteries (INOCAs), heart failure, cardiomyopathies, and systemic diseases like diabetes and chronic kidney disease. Beyond risk stratification, CFR is used to guide therapeutic decisions, including revascularization strategies and tailoring of pharmacological interventions. The integration of CFR assessment into clinical practice, supported by recent guideline recommendations, represents a shift towards personalized, physiology-based cardiovascular care. Full article

Background: Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a heterogenous clinical syndrome in which aetiologies range from “true” ischemic mechanisms to non-ischemic mimics (e.g., myocarditis and Takotsubo syndrome). Cardiac magnetic resonance (CMR) plays a central role in the diagnostic pathway. Recent advances in parametric mapping (native T1, T2, and extracellular volume ECV) and evolving AI/radiomic methods promise to further improve diagnostic accuracy and prognostic stratification. This review aims to evaluate the current CMR evidence in MINOCA, while highlighting parametric mapping advances and future directions in the sphere of AI and radiomics. Methods: A systematic literature search of PubMed and the Directory of Open Access Journals (DOAJ) was performed. We included original prospective and retrospective CMR studies of MINOCA and MINOCA-like presentations in adults. Data were extracted into a master dataset and synthetised thematically into five subsections: (1) diagnostic yield, (2) reclassification rate), (3) timing of CMR, (4) prognosis, and (5) future directions. Results: Twenty-two studies met the inclusion criteria. CMR diagnostic yield varied by protocol and timing but was consistently substantial. CMR consistently reclassified initial MINOCA diagnoses (ischemia or alternative non-ischemic diagnoses). Parametric mapping provided incremental diagnostic and prognostic information. Across studies, early imaging (ideally within the first 1–2 weeks) increased diagnostic yield, while delayed CMR reduced detectability of transient lesions. Early AI and radiomics work show promise for LGE-based classification and for predicting post-contrast findings from non-contrast data, but current models require larger, multicentre training and robust external validation. Conclusions: CMR increases diagnostic yield and reclassification rates in MINOCA, particularly when performed early and with standardised T1/T2/ECV mapping. Mapping not only improves detection of inflammatory and diffuse injuries but also contributes to prognostic stratification. High-resolution LGE, OCT, and AI/radiomics are promising future refinements but need prospective validation in large, early, mapping-inclusive cohorts. Full article

The present review focuses on the particulars of the hemodynamic assessment of patients with Takotsubo syndrome (TTS), i.e., blood pressure, cardiac output, systemic vascular resistance, left ventricular ejection fraction, left ventricular–arterial coupling (VAC), left ventricular end-diastolic pressure (LVEDP), and their importance in the management of patients with TTS, and the unraveling of its pathophysiology. In addition, the review discusses the discrepancies noted in the reported literature on the LVEDP and the left VAC, speculating as to the underlying reasons, and providing recommendations. Full article

Myocardial infarction with non-obstructive coronary arteries (MINOCA) represents a heterogeneous clinical entity encompassing multiple ischemic mechanisms, including atherosclerotic plaque disruption, coronary artery spasm, coronary microvascular dysfunction, coronary embolism, and spontaneous coronary artery dissection. Despite the absence of obstructive coronary disease, patients with MINOCA remain at substantial risk of adverse cardiovascular outcomes, underscoring the need for accurate early diagnosis and effective risk stratification. In this context, accumulating evidence indicates that circulating serum biomarkers may provide additional pathophysiological and prognostic insights in patients with a working diagnosis of MINOCA. Moreover, distinct biomarker profiles may help support the differential diagnostic evaluation between MINOCA and other causes of acute myocardial injury, such as myocardial infarction with obstructive coronary arteries, myocarditis, and Takotsubo syndrome. This narrative review summarizes current evidence on serum biomarkers in MINOCA, highlights their potential role in guiding tailored diagnostic strategies, and discusses future perspectives toward biomarker-driven precision medicine in patients presenting with acute myocardial injury. Full article

Takotsubo syndrome (TTS) is a temporary and reversible form of cardiomyopathy that clinically mimics acute coronary syndrome, typically triggered by intense physical or emotional stress. It mainly affects postmenopausal women and exhibits significant variation among individuals regarding its onset, progression, and outcomes. Although significant advances have been made since its initial description in 1990, the underlying pathophysiological mechanisms remain incompletely understood, limiting the development of effective prevention and targeted treatment strategies. A potential genetic predisposition has been suggested, supported by reports of familial clustering; however, a systematic and updated characterization of genetic and epigenetic factors associated with TTS is still lacking. This systematic and critical review aims to offer a comprehensive overview of current evidence on genetic susceptibility and epigenetic biomarkers potentially involved in the pathogenesis of TTS. Due to the heterogeneity and inconsistency of available findings, particular attention is also given to the methodological limitations of existing genetic studies. Finally, the review examines emerging multimodal approaches that may offer new perspectives for understanding the complex biological foundations of this syndrome. Full article

Objective: Takotsubo syndrome (TTS) is an acute form of heart failure characterized by transient left ventricular systolic dysfunction. Given the complex cardiohepatic interactions observed in heart failure, this study aimed to evaluate the prognostic significance of hepatic T1 mapping in patients with TS. Materials and Methods: In this retrospective pilot study, cardiovascular magnetic resonance (CMR) including hepatic T1 mapping was performed in 66 consecutive patients with TTS (60 females; mean age 70.96 ± 10.11 years). The median duration of long-term follow-up was 7 months (interquartile range, 2–16 months). The primary endpoint was a composite of out-of-hospital all-cause mortality and major cardiovascular or cerebrovascular adverse events, including heart failure hospitalization, TTS recurrence, and ischemic stroke. Results: During the median follow-up period of 7 months, 12 (18%) patients experienced the primary endpoint. Kaplan–Meier analysis revealed a significantly lower event-free survival in patients with higher hepatic T1 values (log-rank, p = 0.001). In multivariable Cox regression analysis, hepatic T1 mapping emerged as an independent predictor of adverse outcomes (HR 1.010; 95% CI 1.002–1.017, p = 0.010). Conclusions: Elevated hepatic T1 mapping values were independently associated with an increased risk of adverse cardiovascular events during follow-up. Incorporating hepatic T1 mapping into the clinical evaluation of patients with TTS may improve risk stratification and support more personalized management strategies. Full article

Takotsubo syndrome (TTS) is an acute and reversible form of heart failure characterized by transient left ventricular dysfunction, typically triggered by acute stress stimuli. TTS, also referred to as “stress cardiomyopathy”, may paradoxically be triggered not only by negative stressors but also by intense positive emotional experiences. Interestingly, TTS was sharply incremented during and following the COVID-19 pandemic. Despite increased clinical recognition, reliable biomarkers for early diagnosis and prognosis remains limited. Oxidative stress is increasingly recognized as a key mechanism in TTS, acting downstream of sympathetic overactivation, thus contributing to myocardial stunning, endothelial dysfunction, and inflammation. In this context, extracellular vesicles (EVs) have emerged as key mediators of intercellular communication and as potential circulating biomarkers, as they reflect the molecular state of their cells of origin. In this review, we summarize the current diagnostic approaches for TTS, including the InterTAK Diagnostic Score, imaging gold standards, and emerging biomarkers such as circulating miRNAs and EV cargo associated with TTS. Furthermore, we critically examine the mechanistic interplay between oxidative stress and EVs in TTS, highlighting translational perspectives and future directions for integrating EV-based biomarkers into personalized clinical management. Full article

We report the case of an 80 yo female patient with cardiovascular risk factors and previous diagnosis of Tako-Tsubo syndrome, who was referred to our institution one year after a previous diagnosis, due to symptoms suggestive of acute coronary syndrome (SCA) after severe emotional stress. After ruling out suspected CAD by cardiac computed tomography (CCT) and subsequent invasive coronary angiography (ICA) confirming no significant stenosis but presence of vulnerable plaque, the patient underwent further investigation by cardiac magnetic resonance (CMR) that confirmed a clinical picture compatible with recurrence of Tako-Tsubo syndrome. Our case underlines the importance of multimodality imaging to guide diagnosis and treatment in this specific clinical scenario. Full article

Biventricular Takotsubo cardiomyopathy (TCM) is a rare variant characterized by involvement of both the left and right ventricles. This variant is associated with greater hemodynamic instability and longer hospital stays compared to the isolated left ventricular-only variant. We report the case of a 67-year-old female patient who underwent elective resection of a left adrenal adenoma. While her preoperative and intraoperative courses were uneventful, she developed cardiogenic shock postoperatively, necessitating prolonged intensive care unit (ICU) management and vasopressor support. Further evaluation revealed elevated high-sensitivity troponin levels and reduced ejection fraction on echocardiography (30–35%). Hypokinesis was noted in the apical and mid-ventricular segments of both ventricles. A coronary angiogram performed two months prior to admission showed no significant coronary artery disease. Based on these findings, a diagnosis of biventricular TCM was established. The patient was managed supportively and discharged in stable condition with ongoing therapy, including beta-blockers, renin–angiotensin–aldosterone system inhibitors (RAASis), and statins. Follow-up echocardiography showed resolution of regional wall motion abnormalities. Although rare, biventricular TCM is associated with increased severity and a higher risk of complications. Early recognition and timely management are essential to improve outcomes in affected patients. Full article

Takotsubo syndrome (TTS), popularly known as “broken heart syndrome”, is a type of reversible but not benign acute heart failure condition of unknown etiology, usually triggered by physical or emotional stress, affecting primarily elderly women. Recently a subtype of TTS, triggered by positive/pleasant emotions, has been identified (“happy heart syndrome”) with affected patients showing the same complications, including in-hospital and long-term mortality, as the patients afflicted with the “broken heart syndrome”. There is a need to increase the awareness of physicians, other medical providers, our patients, and the general public about the existence of “happy heart syndrome”. Full article

Takotsubo syndrome (TTS) is an acute condition involving left ventricular dysfunction that may present clinically as acute coronary syndrome without obstructive coronary disease or congestive heart failure. Initially considered benign, TTS is now recognized as a complex neurocardiac disorder with hospital morbidity rates comparable to those of myocardial infarction, as well as similar long-term risks. Recent evidence establishes TTS as a multifactorial process involving catecholamine overload, coronary microvascular dysfunction, myocardial energetic abnormalities, and dysregulation of the brain and heart axes. Developments in echocardiography, cardiac magnetic resonance imaging, and improvements in diagnostic criteria have enhanced the recognition of syndromic phenotypes. Management of TTS continues to remain primarily supportive; however, recent studies have revealed improved functional outcomes with structured cardiac rehabilitation and cognitive behavioral therapies as the first long-term disease-altering approaches. Future studies should combine neurocardiology, imaging, and therapy-focused research. This review integrates the understanding of the epidemiology, pathophysiology, clinical features, diagnostic work-up, and management of TTS, with particular emphasis on developments emerging from the past decade. Full article

Background: Takotsubo syndrome (TTS) may mimic acute coronary syndrome (ACS) by sharing a similar presentation, electrocardiogram (ECG) findings, and elevated troponin. Different ECG abnormalities may be encountered on presentation in patients with TTS, with ST elevation being the most common. In the current study, we aimed to evaluate the association of different ECG patterns on outcomes of patients with TTS. Methods: Patients hospitalized for TTS between 2018 and 2024 were included in the study. Demographic, echocardiographic, electrocardiographic, and laboratory parameters were obtained. Patients were classified according to ECG into two main groups, with and without ST segment elevation. We compared echocardiographic parameters and clinical outcomes between the two groups. Results: A total of 119 patients (mean age 70, 97% females) were included in the final analysis. The mean left ventricular ejection fraction (LVEF) was 45%, and 59 (50%) of the patients had ST segment elevation on ECG. Patients with ST elevation had lower LVEF, higher troponin levels, and a higher rate of complications related to heart failure (HF) and arrhythmia. After adjusting for potential confounders, only reduced LVEF was associated with an increased rate of complications. There was no difference in readmission rate between patients with or without ST elevation. Conclusions: Patients with TTS presenting with ST segment elevation exhibit more severe disease, reflected by lower LVEF and higher troponin levels, albeit without increased risk for readmission. Full article

Background: Takotsubo cardiomyopathy (TTC), also known as stress-induced cardiomyopathy, is an acute but reversible form of left ventricular dysfunction, most commonly triggered by physical or emotional stress. Although well documented in cardiology practice, its occurrence following hepatobiliary surgery is rarely reported. Case presentation: We describe the case of a 67-year-old woman with a history of arterial hypertension and prior cholecystectomy who was admitted for elective hepatobiliary surgery due to choledocholithiasis complicated by a liver abscess. She underwent laparotomy with choledocholithotomy, hepaticojejunostomy, and abdominal drainage. The postoperative course was complicated by intra-abdominal bleeding, requiring reoperation, and subsequent intestinal leakage, necessitating a second re-laparotomy. On the tenth postoperative day after the second surgery, she developed chest discomfort and dyspnea upon minimal exertion. Electrocardiography revealed T-wave inversions in leads V3–V6, while echocardiography demonstrated a reduced ejection fraction of 45% with apical akinesis. Plasma levels of N-terminal pro-B-type natriuretic peptide (NT–proBNP) were elevated, whereas troponin remained within normal limits. Coronary angiography excluded obstructive coronary artery disease, and ventriculography confirmed apical ballooning consistent with Takotsubo cardiomyopathy. Conclusions: This case highlights Takotsubo cardiomyopathy as a rare but important postoperative complication of major hepatobiliary surgery. Awareness of this condition in surgical patients presenting with acute chest symptoms is essential, as timely recognition and differentiation from acute coronary syndrome directly influence management and prognosis. Full article

Long QT associated with pheochromocytoma is rare but clinically significant. A 43-year-old woman presented with palpitations, chest pain, and recurrent syncope. ECG showed ST-segment elevation, while coronary angiography revealed normal arteries but Takotsubo-like left ventricular dysfunction. Hypertension and tachycardia raised suspicion for pheochromocytoma, later confirmed by imaging and biochemical tests. The patient exhibited QT prolongation (QTc 570 ms) in parallel with Takotsubo episodes. Following adrenalectomy, both QT duration and ventricular function normalized. The European Society of Cardiology now classifies pheochromocytoma-induced cardiomyopathy within the Takotsubo spectrum. Early recognition is crucial due to the risk of sudden cardiac death. Full article

Background: Takotsubo syndrome (TTS) often mimics anterior ST-elevation myocardial infarction (STEMI) caused by left anterior descending (LAD) occlusion, yet the two entities differ fundamentally in pathophysiology and mechanical behavior. Two-dimensional speckle-tracking echocardiography (2D-STE) enables detailed assessment of left ventricular (LV) deformation beyond conventional ejection fraction (LVEF). This meta-analysis compared global and regional LV strain patterns in TTS versus LAD-related anterior STEMI during the acute phase. Methods: A systematic search of PubMed, Embase, and Scopus through October 2025 identified observational case–control studies directly comparing TTS and angiographically confirmed anterior STEMI, with LV mechanics assessed by 2D-STE. Random-effects models were used to pool standardized mean differences (SMDs) for LVEF; global longitudinal strain (GLS); apical, mid-ventricular, and basal longitudinal strain (ALS, MLS, BLS); and global radial strain (GRS). Heterogeneity (I²), publication bias (funnel plots, Egger’s test), meta-regression, and leave-one-out sensitivity analyses were performed. Results: Six studies comprising 221 TTS and 290 anterior STEMI patients met the inclusion criteria. TTS patients were older, predominantly female, and had fewer metabolic risk factors, while LV size was comparable. LVEF was significantly lower in TTS (SMD −1.149; 95% CI −2.20 to −0.10; p = 0.032), with stable findings across sensitivity analyses and no evidence of publication bias. GLS, ALS, MLS, and BLS showed only a non-significant trend toward greater impairment in TTS, and these comparisons were limited by marked inter-study heterogeneity. In contrast, GRS was significantly and consistently more reduced in TTS (SMD −1.284; 95% CI −1.59 to −0.98; p < 0.001), indicating more profound global radial dysfunction. Meta-regression showed no significant influence of demographic factors or vendor-specific software on LVEF or GLS differences. Conclusions: Compared with LAD-related anterior STEMI, TTS is associated with more severely depressed LVEF and markedly impaired radial strain, while longitudinal strain differences remain inconclusive and suggest only a potential trend toward greater dysfunction, reflecting the limited and heterogeneous evidence. These findings are consistent with diffuse, stress-induced myocardial stunning in TTS and suggest that 2D-STE may aid differentiation between stress cardiomyopathy and ischemic infarction in the acute setting, although longitudinal strain parameters should be interpreted cautiously and regarded as hypothesis-generating. Full article