Takotsubo cardiomyopathy induced during dobutamine stress echocardiography: an exhaustive review

Abstract Funding Acknowledgements Type of funding sources: None. Introduction. Takotsubo cardiomyopathy (TTC) mimics an acute coronary syndrome and corresponds to reversible stress-induced cardiomyopathy. Dobutamine Stress Echocardiography (DSE) has been widely used for more than 30 years is considered as one the gold standard non-invasive test detect myocardial ischemia. DSE responsible a TTC rare clinical entity. Purpose. induced takotsubo Cardiomyopathy (TTC-DSE) exceptional situation. We systematically search TTC-DSE observations analyse specific characteristics such cohort. Methods Results. conducted extensive in Medline, Cochrane Central Registry Controlled Trials, using key words "acute cardiomyopathy, DSE". File selection was based on following criteria : (a) occurrence during DSE, (b) Mayo Clinic (1) associating transient left ventricular systolic dysfunction, absence significant stenosis, ST-T abnormalities EKG, moderate troponin elevation, pheochromocytoma or myocarditis. identified published between 2006 2019, mostly from USA Europe publications. Symptoms appear at high dobutamine dosages (30 40 gammas/kg/min: 24/30), rarely recovery (4/30). These patients have typical features strong predominance female population (26 women; 86.7%), aged over 50 (24; 93.3%); (2) depression and/or anxiety (8 pts; 26.7%); (3) ECG: ST elevation (21 70 %), (2 pts), no change (4 conduction block (3 pts); (4) emergency angiography without lesion; (5) angiographic ejection fraction (LVEF), calculated 18/30pts < 40% 14/18 (6) segmental LV impairment (echo angio): apical n = 17 (77.3%); mid-ventricular 3 (13.6%); reverse 2 (9%) unspecified (7) low peak Troponin: 2.65 ± 2.04 ng/ml; (8) death heart failure (old lady 86 age, with intra gradient), rapid LVEF other (29 pts). Despite heterogeinity large cohort publications, comparable caracteristics. Conclusion. exceptional, but severe complication DSE. It provides unique opportunity observe phase. observational studies show similar profile patients. Mortality remains cohort, probably because prompt interruption test. Rapid function consistent. High level sympathetic stimulation secondary infusion, frequent associated are major determinants TTC-DSE. However, rarity TTC-DSE, compared widespread daily practice echo-laboratories, unexplained.