Multimodality Imaging in Preserved-Ejection-Fraction Takotsubo Syndrome with Dynamic Left Ventricular Outflow Tract Obstruction: An Acute Coronary Syndrome Mimic

Takotsubo syndrome may mimic acute coronary syndrome even when global systolic function is preserved. A 77-year-old postmenopausal woman presented with exertional chest pain, presyncope, hypotension, mild lateral ST-segment elevation, and transient high-sensitivity troponin T elevation. Coronary angiography showed nonobstructive coronary arteries. Transthoracic echocardiography demonstrated preserved left ventricular ejection fraction, circumferential apical dysfunction, basal hypercontractility, moderate mitral regurgitation, and dynamic left ventricular outflow tract obstruction caused by chordal systolic anterior motion. Speckle-tracking showed apical–basal strain dissociation despite preserved ejection fraction. Cardiac magnetic resonance provided tissue characterization, showing no acute myocardial edema, infarct-pattern scar, perfusion defect, or microvascular obstruction, while follow-up echocardiography demonstrated recovery of regional wall motion and mitral regurgitation. This case highlights multimodality imaging in the diagnostic work-up of Takotsubo syndrome, with echocardiography providing decisive diagnostic and hemodynamic information.