Table 3.
Cardiac laboratory and paraclinical findings
| Study, year | ECG findings | TTE findings | CA findings | Troponin elevation | BNP elevation | Creatine kinase elevation |
|---|---|---|---|---|---|---|
| Takotsubo after COVID‐19 | ||||||
| Nguyen et al. (2020) 19 | Sinus rhythm with prolonged QT interval (QTc 521 ms) | NR | Significant lesions on the proximal LAD and the first diagonal arteries. The ventriculogram showed regional wall motion abnormality unrelated to the coronary lesions, compatible with a median takotsubo. | Positive | NR | NR |
| Panchal et al. (2020) 20 | Nonspecific ST‐T wave abnormality (QTc 420 ms, QTc 439 ms on admission) | New left ventricular (LV) regional wall motion abnormality with hypokinesis of the basal to midsegments and hyperkinetic apical segments | NR | NR | NR | NR |
| Kariyanna et al. (2020) 21 | Normal range sinus rhythm, Q waves in V1–V2 leads and Q waves with ST segment elevation V3, V4, V5 and deep T wave inversion in V6 | Diffuse hypokinesis with distinct regional wall motion abnormality, apical dyskinesis or apical systolic ballooning suggestive of stress induce cardiomyopathy | NR | Positive | Positive | NR |
| Alizadehasl et al. (2022) 22 | Sinus tachycardia with mild dynamic ST segment depression in precordial leads | Akinesia in mid‐to‐apical segments of both ventricles compatible with biventricular apical ballooning syndrome | NR | Positive | NR | NR |
| Fujisaki et al. (2021) 23 | Atrial fibrillation, poor R progression, and negative T waves in lead I, aVL, and V2–V6 | Severe hypokinetic biventricular apical and mid segments | NR | Positive | Positive | NR |
| Demertzis et al. (2020) 24 | Normal range sinus rhythm, QTc 387 ms | New reduced EF (40%) and severe hypokinesis of the basal–mid inferoseptal, inferior, anteroseptal, and anterior walls | NR | Positive | NR | Positive |
| Normal sinus rhythm, QTc 427 ms | Large pericardial effusion with signs of right ventricular dysfunction and apical hypokinesis | NR | Positive | Positive | NR | |
| Torabi et al. (2021) 25 | Low voltage in the limb leads | Hyperdynamic left ventricle and a hemodynamically significant moderate‐sized pericardial effusion with right atrial systolic collapse. The LV apex was dilated with systolic hypokinesis and basal segments had preserved contraction | Normal range coronaries and mildly elevated left ventricular end diastolic pressure | Positive | Positive | NR |
| Ortuno et al. (2021) 26 | Non‐elevated ST segment, prolonged QT interval, T wave inversion | Left ventricular failure with reduced ejection fraction (LVEF 40%) and typical apical ballooning suggesting | Positive | NR | NR | NR |
| Hegde et al. (2020) 27 | Atrial flutter RVR with diffuse ST elevations | Left ventricular EF: 15% | NR | Positive | Positive | NR |
| Atrial fibrillation, with RVR, diffuse deep T‐wave inversions | Left ventricular EF: 53% | NR | Positive | Positive | Positive | |
| Sinus rhythm with diffuse ST‐T changes | Left ventricular EF: 45% | NR | Negative | Negative | Negative | |
| Sinus rhythm with deep T‐wave inversions | Left ventricular EF: 20% | NR | Positive | Positive | Negative | |
| Atrial fibrillation, with diffuse ST‐T changes | Left ventricular EF: 30% | NR | Positive | Positive | Negative | |
| Sinus tachycardia with PACs and T‐wave inversions | Left ventricular EF: 40% | NR | Positive | Negative | Negative | |
| Sinus tachycardia with diffuse ST‐T changes | Left ventricular EF: 45% | NR | Positive | Positive | Positive | |
| Hoepler et al. (2021) 28 | Complete right bundle branch block (QRS 160 ms) with T wave inversions in leads I, aVL, and V3–V6. Three days later, the QRS complex was normal range again but T wave inversions were more pronounced | Severe hypo‐ to akinesia in parts of the apical and the inferoapical wall with hypercontractility of the basal segments of the heart | Normal‐range coronary arteries | Positive | NR | Negative |
| ST‐elevations and negative T waves in leads V4 and V5 and isolated negative T waves in leads II, III, aVF, and V6 (the patient later developed persistent T wave inversions in II, III, aVF, and V2 to V6) | Moderately reduced systolic function and apical, anterior, and posterolateral akinesia | Severe three‐vessel coronary artery disease (CAD), but also TT cardiomyopathy with classic apical ballooning and hyperkinesia of the basal segments | Positive | Positive | Positive | |
| Hyperacute T waves, which were later replaced by deep T wave inversions in V3 to V6 | Severe apical akinesia with hyperkinesia of the basal segments and a minimum ejection fraction (EF) of 20% after it had been only moderately reduced 2 days earlier | Positive | Positive | Positive | Negative | |
| Alshamam et al. (2021) 4 | ST‐segment elevation in leads V1–V5 and T‐wave inversions in leads I and aVL | Mid to apical left ventricular (LV) akinesia with preserved function in the proximal and segment, aortic valve sclerosis, reduced excursion of Trileaflet valve (without stenosis), and mild‐to‐moderate tricuspid regurgitation with moderate pulmonary artery systolic pressure (PASP) | NR | Positive | Positive | Positive |
| Bernardi et al. (2020) 29 | ST‐segment elevation in anterolateral leads, suggesting an acute myocardial infarction | Dilated left ventricle with akinesis of the mid and apical ventricle segments with hyperkinesis of the basal segments and severe systolic dysfunction (left ventricle ejection fraction calculated by Simpson's biplane method [LVEF]: 30%); first‐grade diastolic dysfunction; partial left ventricle outflow tract obstruction determining a late maximal gradient of 56 mmHg with systolic anterior motion of the mitral valve and associated moderate to severe mitral regurgitation; and, finally, 2 large apical thrombotic formations: the positive terior one was elongated (maximum: 31 mm) and mobile, and the anterior one was wide and oval | Positive | Positive | Positive | Negative |
| Sattar et al. (2020) 30 | Atrial fibrillation with a rapid ventricular response, right bundle branch block (RBBB), and T‐wave inversions in the inferolateral leads | Left ventricle ejection fraction (LVEF) of 30% with diffuse anterior wall and apical akinesia and apical ballooning | Positive | NR | NR | NR |
| Tsao et al. (2020) 31 | Slight ST‐segment elevations diffusely with nonspecific T‐wave inversions | Severe hypokinesis of the mid‐left ventricular cavity, with normal range‐to‐hyperdynamic contractility of basal and apical left ventricular segments and a moderately reduced biplane ejection fraction of 36% | Positive | Negative | Positive | Negative |
| Gomez et al. (2020) 32 | Sinus tachycardia without ST‐wave or T‐wave changes, prolonged QTc interval of 516 ms and low‐voltage QRS in the precordial leads | Depressed left ventricular ejection fraction of 25%–30%, with severe hypokinesis of the mid‐to‐apical segments and preserved basal myocardial function | Positive | Positive | Positive | Negative |
| Belli et al. (2021) 18 | ST elevation with biphasic T waves and Q waves | Complete apical ballooning and extensive akinesia spanning multiple coronary territories with a global LV systolic function impairment | Nonsignificant 30% stenosis of the left anterior descending coronary artery with otherwise smooth coronary arteries | Positive | Positive | NR |
| Titi et al. (2020) 33 | Diffuse ST segment elevation, more evident in the precordial leads (V3–V5), and Q waves in precordial and peripheral inferior leads | Severe global reduction of the left ventricular contractility with mild pericardial effusion | 70% stenosis in the posterolateral branch which originated from the circumflex (left dominance) | NR | NR | NR |
| Faqihi et al. (2020) 34 | Sinus tachycardia (115 beats/min) and nonspecific ST‐segment and T‐wave abnormalities in the precordial leads | LV basal and midventricular akinesia with apical sparing | NR | Positive | NR | Positive |
| Solano, López et al. (2020) 35 | 2 mm ST elevation Inf and Lat lids | Akinesia of all basal segments | Normal range coronary arteries, left ventricular angiography presented basal segment akinesia and hypercontractility of the mid‐apical segments with elevated diastolic pressure | Positive | Positive | NR |
| Pasqualetto et al. (2020) 36 | Diffuse negative T waves on precordial leads with QT interval prolongation | Dyskinesia of the left ventricle apex (apical ballooning) and basal wall hypercontractility with systolic dysfunction, global preserved left ventricular ejection fraction (EF) of 53% | The autopsy confirmed a normal‐range coronary anatomy. | Positive | Positive | NR |
| Diffuse negative T waves on precordial leads with QT interval prolongation | Dyskinesia of the left ventricle apex (apical ballooning) and basal wall hypercontractility with systolic dysfunction, LVEF (30%) | Negative for significant coronary stenosis | Positive | Positive | NR | |
| Diffuse negative T waves on precordial leads with QT interval prolongation | Dyskinesia of the left ventricle apex (apical ballooning) and basal wall hypercontractility with systolic dysfunction, moderately impaired LVEF (42%) | Negative for significant coronary stenosis | Positive | Positive | NR | |
| Koh et al. (2021) 37 | There were diffuse ST‐segment elevations and PR‐segment depressions in the inferolateral leads. There were also ST‐segment depressions and PR‐ segment elevations in leads V1, aVR | Biventricular systolic dysfunction with a left ventricular ejection fraction (LVEF) of around 30%. This demonstrated global left ventricular hypokinesia (biplane LVEF 32.7% with average left ventricular [LV] global longitudinal strain of −8.7%). There was moderate right ventricular systolic dysfunction with a tricuspid annular plane systolic excursion of 11.7 mm, estimated pulmonary artery systolic pressure of 42 mmHg, borderline pulmonary artery acceleration time (120 ms) and echocardiographic estimated pulmonary vascular resistance of 3.41 wood units. A small pericardial effusion was also found. CMR showed an improved LVEF of 66%. There was maximal LV wall thickness of 8 mm at the basal anteroseptal segment, normal range right ventricular systolic function and indexed volumes and there was no late gadolinium enhancement (LGE) in the myocardium of both ventricles or myocardial edema | Normal range epicardial vessels with slow coronary flow. Left ventriculography revealed global left ventricular hypokinesia with severe left ventricular systolic dysfunction | Positive | NR | NR |
| Dave et al. (2020) 38 | Sinus tachycardia and nonspecific T‐wave abnormality in the lateral leads | Normal range right ventricular function, left ventricular ejection fraction (LVEF) 26% with preserved basal function, and apical ballooning consistent with takotsubo cardiomyopathy | NR | Positive | Positive | NR |
| Van Osch et al. (2020) 39 | Negative T‐waves were observed at the monitor and a 12‐lead ECG was obtained which showed sinus rhythm with diffuse, new, deeply negative T‐waves and a prolonged QTc interval of 505 ms | A poor left ventricular systolic function [left ventricular ejection fraction (LVEF) approximately 30%] with circumferential akinesia of the apex in the mid‐ventricular and apical segments and circumferential hyperdynamic contractions of the basal segments consistent with the diagnosis takotsubo cardiomyopathy | Low calcium score and a nonsignificant stenosis (<50%) in the proximal left anterior descending | Positive | NR | NR |
| Bhattacharyya et al. (2020) 40 | Inferolateral ST‐segment elevation | Hypokinetic mid and akinetic apical left ventricular (LV) segments and hypercontractile basal segments with prominent apical ballooning typical of takotsubo cardiomyopathy (TTC). Two‐dimensional speckle tracking echocardiography revealed LV global longitudinal strain (GLS) of −13.9 and ejection fraction (EF%) of 38% | Non‐obstructive coronary artery disease (CAD) involving the left anterior descending artery | Positive | Positive | NR |
| Taza et al. (2020) 41 | ST segment elevations in the inferior leads (II, III, aVF) | NR | Non‐obstructive coronary arteries and apical ballooning on ventriculography, consistent with takotsubo syndrome | Negative | NR | NR |
| Bottiroli et al. (2020) 42 | ST‐segment elevation with loss of R‐waves in leads V2 to V4 | Normal range size of ventricular chambers, severe left ventricular (LV) systolic dysfunction with an LV ejection fraction (EF) of 25%, and akinesia of middle and apical segments (apex ballooning) with hyperkinetic motion of basal segments | NR | Positive | Positive | NR |
| Roca et al. (2020) 43 | The electrocardiogram showed negative T waves and repolarization phase alterations | Alterations in the left ventricle: apical akinetic expansion (apical ballooning) and hypokinesia of the mid‐ventricular segments with slightly reduced systolic function (ejection fraction slightly reduced to 48%) | NR | Positive | NR | Positive |
| Oyarzabal et al. (2020) 44 | The electrocardiogram showed a 1 mm ST segment elevation in leads V2–V3 and DI‐AVL | The findings of ventriculography were confirmed by echocardiography | Coronary angiography showed coronary arteries free of lesions and cardiac ventriculography was performed. This showed a very reduced left ventricular ejection fraction with extensive apical akinesia | NR | NR | NR |
| Minhas et al. (2020) 45 | Sinus tachycardia and 1‐mm upsloping ST‐segment elevations in leads I and aVL, mild diffuse PR interval depressions, and diffuse ST‐T wave changes | Akinetic middle to distal anterior, anteroseptal, antero‐lateral, and apical segments, moderately hypokinetic middle and distal inferolateral segments, and hyper‐dynamic basal segments. Apical ballooning was also noted. Left ventricular (LV) ejection fraction was 20%. The distal third or apical right ventricular (RV) free wall was akinetic, with hyperdynamic RV basal wall motion. RV function was mildly reduced | NR | Positive | NR | NR |
| Kong et al. (2021) 46 | Anteroseptal ST‐segment elevations | NR | Mild non‐obstructive coronary artery disease, and a left ventriculogram was performed which demonstrated preserved basal function with apical akinesis, consistent with TTS | Positive | NR | NR |
| New ST‐segment elevations in the anterolateral leads | Apical hypokinesis, consistent with ventriculogram findings | Non‐obstructive coronary artery disease. A left ventriculogram demonstrated significantly reduced ejection fraction with preserved basal function and apical ballooning and akinesis, consistent with TTS. Right heart catheterization showed elevated biventricular filling pressures with reduction in CO and CI | Positive | NR | NR | |
| Park et al. (2020) 47 | T wave inversion appeared | Apical ballooning with severe LV systolic function | NR | Positive | Positive | NR |
| NR | Apical ballooning with dyskinetic movement and severe LV systolic dysfunction | NR | Positive | NR | Positive | |
| Meyer et al. (2020) 48 | <1 mm ST‐segment elevation in all precordialleads with deep T‐wave inversions | Typical left ventricular apical ballooning with hyperkinetic basal segments | Nonsignificant lesions with a typical takotsubo syndrome (TTS) image on ventriculography | Positive | NR | NR |
| Eftekharzadeh et al. (2022) 49 | Tachycardia and ST‐segment elevation in inferior lateral leads II, III, aVF, and V5 | NR | A 40% proximal to mid‐left anterior descending (LAD) lesion without any severe obstruction, moderate left ventricular (LV) dysfunction with apical ballooning was noted during the left heart chamber assessment | Positive | Positive | NR |
| Frynas‐Jończyk et al. (2022) 50 | Sinus rhythm of 80/min, left anterior fascicular block, ST‐segment depression in V1‐V5 leads, and negative T waves in II, III, aVF, V1–V6 leads | Apical dyskinesis resulting in apical ballooning and hypo‐akinesia of the mid‐ventricular segments with severely reduced left ventricular ejection fraction (LVEF) of 30% | Mild, non‐obstructive atherosclerotic plaques in the coronary arteries | Positive | Positive | Negative |
| Fujiyoshi et al. (2022) 51 | Deep T‐wave inversions in all precordial leads | Hypokinesis with hypertrophy in the apical region and hyperkinesis in the basal region with estimated LV ejection fraction of 58% | NR | Positive | NR | NR |
| Kimura et al. (2021) 52 | Inverted T‐waves in leads I, II, aVF, and V1–V6 | Apical akinesis with preserved basal function and a depressed ejection fraction of around 50% | NR | Positive | Positive | Positive |
| Mishra et al. (2021) 53 | New onset T wave inversion across V1–V6 | Hypokinesis of the basal region of the left ventricle with hyperkinesis of the apical region of the left ventricle consistent with a reverse takotsubo cardiomyopathy | NR | NR | NR | NR |
| Namburu et al. (2021) 54 | ST elevations in V1–V3 leads consistent with the diagnosis of ST‐elevation myocardial infarction (STEMI) | Left ventricular ejection fraction (LVEF) of 45%, enlarged right ventricle (RV), and a right atrial thrombus | Non‐obstructive coronary artery disease with apical ballooning of the left ventricle, a ventriculogram characteristic of TTC | Positive | NR | NR |
| Rivera et al. (2020) 55 | Atrial fibrillation with rapid ventricular response and ST‐segment elevation in the anterolateral leads | NR | Absence of obstructive coronary lesions and ventriculography showed severe ventricular dysfunction with anterolateral, apical, and inferior dyskinesia and hypercontractility of the basal segments, compatible with takotsubo syndrome (TTS) | NR | NR | NR |
| Wildermann et al. (2022) 56 | Intermittent ventricular bigeminy | NR | Cardiac catheterization showed no coronary artery disease but regional wall motion abnormalities compatible with atypical TTC | Positive | NR | NR |
| Bapat et al. (2020) 57 | Persistence of T wave inversions and progressive prolongation in the QT interval | Preserved left ventricular ejection fraction of 61% but with new apical hypokinesis | Not performed | Positive | NR | NR |
| Chao et al. (2020) 58 |
Narrow QRS, precordial T‐wave inversion, QTc of 467 ms 3 days later: right bundle branch block, prolonged QTc of 539 ms, and mild diffuse ST elevation |
Mild to moderately reduced LVEF of 40% with marked hypokinesis of basal and mid segments and pre‐served wall motion of apical segments | Not performed | Positive | Positive | Positive |
| Dabbagh et al. (2020) 59 |
Low voltage in the limb leads with nonspecific ST‐segment changes serial ECG revealed deep T‐wave inversions in precordial leads (V2–V6) |
Large pericardial effusion circumferentially around the entire heart with signs of early right ventricular diastolic collapse, dilated but collapsing inferior vena cava, and mitral valve inflow variation of 31% on pulsed wave Doppler. LVEF was mildly reduced at 40%, with no regional wall motion abnormalities, similar to TTE 1 year prior. Serial TTE demonstrated resolution of the pericardial effusion; however, the patient was found to have new hypokinesis of the apical and periapical walls concerning for takotsubo cardiomyopathy (TTC) |
Not performed | Positive | NR | NR |
| Manzur‐Sandoval et al. (2021) 60 | Pulse rate 75 beats/min; PR interval 160 ms; QRS interval 100 ms; prolonged QTc interval 551 ms; QRS axis –30°; poor R‐wave progression; giant inverted T waves at V2– V6, DI, and AVL; and Q waves at DII and AVF. | In the apical 2‐chamber view, apical ballooning with normal contraction of the basal segments was observed; left ventricular longitudinal strain was decreased in the mid and apical segments | Not performed | Positive | Positive | Positive |
| Sang et al. (2020) 61 | Septal infarction pattern | Severely reduced left ventricular systolic function with global hypokinesis of the left ventricle. The apical segments had disproportionately poor function compared with the basal segments, a finding consistent with stress‐induced (takotsubo) cardiomyopathy | Not performed | Positive | Positive | NR |
| Tutor et al. (2021) 62 | Nonspecific ST‐T wave changes | Depressed LVEF of 25% with basal‐sparing and severe apical akinesis | NR | Positive | NR | Negative |
| Diffuse t‐wave inversions | Severely depressed LV systolic function, and global hypokinesis with akinesis of the apex and basal sparing | NR | Positive | NR | Positive | |
| Takotsubo after social stress | ||||||
| Habedank et al. (2020) 63 | ST elevations 0.4 mV from J‐point in leads V2 to V4, 0.1 mV in lead aVL, and a QTc = 522 ms by Bazett's resp. 477 ms by Fridericia's formula | Moderate hypokinesia in the mid‐anterior section and cardiac MRI proving significant edema in the entire anterior and septal wall. severe hypokinesia in the mid‐apical segments and hyperdynamic basal segments | Moderate coronary sclerosis | Positive | NR | Negative |
| Giannitsi et al. (2020) 64 | Diffuse ST segment elevation | NR | Excluded stenotic lesions | Positive | NR | NR |
| Parker et al. (2020) 65 | Q waves and ST elevation in the inferior leads | NR | Chronic occlusion of right coronary artery, left ventricular ejection fraction of 34%, and basal hyperkinesis with mid‐ventricular and apical dyskinesis | Positive | NR | NR |
| Uhe et al. (2020) 66 | Negative T‐waves in II, III, aVF, and V3‐6 | Wall motion abnormalities with apical septal dyskinesis, mid ubiquitous akinesia and basal septal and anterior hypokinesis. Left ventricular ejection fraction was reduced to 45%. Global longitudinal strain with a typical strain pattern of apical ballooning was 8% | No signs of artery disease (CAD) | Positive | NR | Positive |
| Chadha et al. (2020) 67 | A septal q‐ST pattern in leads V1–V3 | Basal hyperkinesis and apical ballooning | Nonsignificant coronary artery disease | Positive | NR | NR |
| Rivers et al. (2020) 68 | Diffuse ST elevation | A dilated left ventricle with an akinetic apex and preserved contraction of the basal segments | No obstructive lesions | Positive | NR | NR |
| Koutroumpakis et al. (2020) 69 | A sinus rhythm at 63 beats/min, with marked T wave inversion in the inferior and anterolateral leads | Left ventricular systolic dysfunction with apical ballooning. basal hyperkinesis with dyskinesis of the apex | TIMI 2 flow down the left anterior descending artery | Positive | NR | NR |
| Jabri et al. (2020) 5 | NR | NR | NR | NR | NR | NR |
| Dolci et al. (2020) 70 | Regular sinus rhythm with nonspecific ST‐segment alterations in the inferior leads |
Hypokinesia of the left ventricle (LV) mid segments with normal range apical and basal contraction resulting in mild reduction of LV ejection fraction. Normal range epicardial coronary arteries and confirmed mid‐ventricular ballooning with Normal range contraction of basal and apical segments |
Normal range epicardial coronary arteries and confirmed mid‐ventricular ballooning with Normal range contraction of basal and apical segments | Positive | NR | NR |
| Moady et al. (2021) 71 | Normal sinus rhythm with diffuse ST segment elevation, most prominent in the anterior leads with no reciprocal changes | Moderately reduced global systolic left ventricular function with a typical pattern of apical ballooning and left ventricular outflow obstruction | Basal hypercontractility and apical ballooning were obvious during left ventriculography | Positive | Positive | NR |
| Normal sinus rhythm with anterior ST segment elevation | Reduced apical contraction with estimated ejection fraction of 42% and hyperkinetic basal segments of the left ventricle | Normal arteries | Positive | Positive | NR | |
| Kir et al. (2021) 9 | Sinus tachycardia with inferior Q waves, poor R wave progression, and nonspecific ST‐segment changes |
Basal hyperkinesis with severe apical hypokinesis. An ejection fraction of 45%–50%, with severe hypokinesis of the apical segments with apical ballooning and basal hyperkinesis |
Negative for any significant obstructive coronary artery disease | Positive | Positive | NR |
| New deep T wave inversions in the precordial leads and subtle ST elevation in the inferior leads |
Severe hypokinesis of the antero‐apical wall, concerning for anterior myocardial infarction. severely depressed left ventricular ejection fraction of 30% with antero‐apical and infero‐apical wall akinesis |
Mild calcification and nonobstructive disease in the coronary arteries with a right dominant circulation. Myocardial bridge was noted in the proximal mid left anterior descending artery. Left ventricular end‐diastolic pressure was elevated at 22 mmHg. | NR | NR | NR | |
| Mohammed et al. (2020) 72 | Sinus tachycardia and left bundle branch block | A newly depressed ejection fraction (EF) of 22%, a moderately increased left ventricular (LV) cavity size, and moderate hypokinesis of the mid‐distal left ventricular wall with preservation of basal LV contractility | Normal coronary arteries | Positive | Positive | NR |
| Ben Ammar et al. (2021) 73 | Elevated ST‐segment in leads V3 to V6 | Reduced left ventricular ejection fraction which was 40%, There was also a decrease in the global longitudinal strain with a marked decrease in the apical segments | Severe multivessel disease, tight stenosis in the posterior‐right coronary artery. On the left, there were insignificant lesions in the mid and distal left anterior descending arteries, as well as insignificant lesions in the mid‐circumflex and second obtuse marginal arteries. | Positive | NR | NR |
| Takotsubo after COVID‐19 vaccination | ||||||
| Vidula et al. (2021) 11 | Inferolateral T wave inversions | Mildly reduced LV function with apical akinesis | A patent LAD stent and no obstructive disease | Positive | NR | NR |
| Boscolo‐Berto et al. (2021) 74 | Negative T waves over the inferior/anterior leads |
Apical ballooning. mid‐ventricular to apical ballooning (asterisk) with preserved basal contraction (blues arrows) and a moderately impaired left ventricular ejection fraction of 40% |
No coronary artery disease | Positive | Positive | Negative |
| Fearon et al. (2021) 75 | ST wave changes concerning for infero lateral ischemia and new poor anterior R wave progression | Mid‐ventricular ballooning of the LV, EF 20% with a Grade I diastolic dysfunction, mild mitral regurgitation, and severe right ventricular dysfunction associated with functional severe tricuspid regurgitation | No significant coronary artery disease | Positive | Positive | NR |
| Crane et al. (2021) 76 | Sinus tachycardia with first degree and right bundle branch block without acute or dynamic ischemic changes | New moderately severe segmental systolic dysfunction with an estimated ejection fraction of 37%–39% with hyperdynamic base, akinesis of the mid‐distal left ventricular segments and severe hypokinesis of the apical cap with apical ballooning | Patent grafts, no new flow limiting coronary disease and left ventriculography consistent with transthoracic echocardiogram finding with apical ballooning and reduced cardiac function in the antero‐apical regions | Positive | NR | NR |
| Stewart et al. (2021) 77 | Anterior T wave inversion with a corrected QT interval of 480ms, which evolved over 48 h | Hypokinesia of the mid‐cavity anteroseptum and the apical septum with overall mildly impaired left ventricular systolic contraction. No significant valvular heart disease, normal dimensions of the atria and ventricles and good right ventricular systolic contraction were noted | Left ventricular hypokinesia of the mid‐cavity anterior wall with no significant coronary artery disease present and left dominant coronary arteries | Positive | NR | NR |
| Tedeschi et al. (2022) 78 | Sinus rhythm with normal atrioventricular conduction, deep and symmetric T‐wave inversion in all leads except for aVL and aVF, and prolongation of corrected QT (QTc) >600 ms | Moderate depression of left ventricular contraction (LVEF 38%) in the presence of hypokinesia of apical and mid‐distal walls consistent with the apical ballooning syndrome | Non‐obstructive coronary artery disease | Positive | NR | NR |
| Toida et al. (2022) 79 | Atrial fibrillation with a normal axis, negative T‐waves in I, aVL, and V3‐6, and a prolonged QTc interval of 495 ms | Akinesia of the apical segments of the LV with apical ballooning and sparing of the base of each wall as well as a reduced ejection fraction of 48%. Systolic anterior motion of the mitral valve (MV) and LV outfow tract obstruction with basal hyperkinesia were detected in addition to mild‐moderate mitral regurgitation. Peak fow velocity and the mean pressure gradient of the LV outfow tract were 4.2 m/s and 71 mmHg, respectively | Not performed (coronary computed tomography showed no significant stenosis of the coronary arteries and extensive akinesis in the apical portion and hyperkinesia in the basal portion of LV with apical ballooning) | Positive | NR | Negative |
| Yamaura et al. (2022) 80 | ST‐segment depression on the V4–V6 leads | Akinesis at the basal portion of the left ventricle (LV) and hypercontraction at the apex | Not performed (coronary computed tomography angiography showed no significant stenosis in epicardial coronary arteries or aortic dissection. Coronary computed tomography angiography depicted akinesis at the basal portion of the LV, as visualized using transthoracic Doppler echo‐cardiography) | Positive | NR | Positive |
Abbreviations: BNP, brain natriuretic peptide; NR, not reported; RVR, rapid ventricular rate; TTE, transthoracic echocardiogram.