Longitudinal strain by speckle tracking echocardiography: Is it useful in clinical practice for differentiating Takotsubo syndrome from anterior myocardial infarction?

Takotsubo syndrome (TTS) is characterized by reversible left ventricular systolic dysfunction that extends beyond the territory of a single coronary artery, in the absence of significant obstructive coronary disease.It can mimic an acute coronary syndrome (ACS), as the clinical presentation typically includes chest pain, ECG changes and elevation of cardiac biomarkers. 1 In terms of differential diagnosis, as pointed out by Pestana et al. in this issue of the Journal, 2 the greatest difficulty may be in distinguishing apical TTS (the most common form) from ACS with anterior ST-segment elevation.The authors compared two groups of patients, one of 17 patients with apical TTS, and the other of 20 patients with anterior ACS, aiming to identify echocardiographic features differentiating between the two groups, using global and regional longitudinal strain.Differential diagnosis between apical TTS and anterior ACS is more difficult in patients with anterior ST-segment