Noninvasive Assessment in Takotsubo Syndrome: A Diagnostic Challenge

Takotsubo syndrome (TTS) is a clinical syndrome characterized by a transient left ventricular dysfunction whose diagnosis can be challenging due to its resemblance to acute myocardial infarction (AMI). Despite the growing recognition of TTS, acute complications and long-term mortality rates are comparable to those observed in AMI patients. In this context, a systematic diagnostic approach is imperative for an accurate patient assessment, with due consideration of the distinctive characteristics and optimal timing of each imaging modality. Coronary angiography with ventriculography may be reserved for cases presenting with ST-segment elevation, whereas in all other cases, the use of multimodality noninvasive imaging allows for a comprehensive evaluation of typical diagnostic features and detection of acute complications while also providing prognostic insights. The aim of this review is to evaluate the current research on non-invasive modalities and to propose a diagnostic algorithm that will facilitate the identification and management of TTS. A systematic diagnostic approach is crucial for accurate assessment in Takotsubo syndrome, given the diagnostic challenge. Multimodality noninvasive imaging is pivotal for a comprehensive evaluation. This encompasses echocardiography for acute complications and rapid identification of typical ventricular wall abnormalities, combined with cardiac magnetic resonance, which is increasingly recognized for the detection of characteristic myocardial oedema and for prognostic assessment. Coronary angiography with ventriculography may be reserved for cases with ST-segment elevation, whereas in other scenarios, multimodality noninvasive imaging, including coronary-CT, allows for prompt differentiation from other conditions, such as myocardial infarction and myocarditis, thus facilitating optimal management and improving outcomes. image