Abnormal Longitudinal Strain in Takotsubo Cardiomyopathy: A Case Report

In recent years, the prognostic utility of global longitudinal strain (GLS) has evolved significantly in the evaluation and management of a wide array of cardiac conditions. Various studies have described the use of GLS in the evaluation of various cardiac pathologies, including heart failure, aortic stenosis, and acute myocardial infarction. Evaluation utilizing speckle-tracking echocardiography (Echo) has been shown to be sensitive in the assessment of global and regional myocardial function. In that context, GLS can be used as a surrogate marker of myocardial function, especially in cases of acute myocardial infarction. Although GLS has been shown as a sensitive marker for myocardial ischemia, it has been a significantly underutilized modality in the evaluation of Takotsubo cardiomyopathy (TC); an acute myocardial stress reaction, which can mimic acute coronary syndrome on presentation. With this case report, we present a case of left ventricular TC with abnormal longitudinal strain affecting the entirety of the apex and all three major coronary artery distribution territories. Our case report illustrates how GLS can be a sensitive marker for myocardial dysfunction in cases of TC. The extent of abnormality and distribution of strain has a pathognomonic 'evil eye' appearance, which was described in previous studies and is consistent with TC. GLS may help identify patients with TC prior to proceeding with left heart catheterization and would be significantly beneficial in TC and may have further implications on the overall prognosis and management of TC in the future.