CONGRESS ABSTRACT

A 72-year-old patient with multiple cardiovascular risk factors reports progressively worsening dyspnea at rest, which began following a period of severe stress (flood damage to their home in Romagna). Due to the persistence of symptoms, the patient is brought to the emergency department, where vital signs reveal: BP 150/110 mmHg, HR 120 bpm, and normal SpO₂. An ECG shows biphasic T waves in leads V5-V6, and a plateau troponin I (TnI) curve (434 to 495 ng/L). The patient is subsequently transferred to the Cardiological Intensive Care Unit (CICU). In the CICU, a repeat ECG reveals an evolving pattern, with negative T waves in the anterolateral and inferior leads and QT interval prolongation. An echocardiogram demonstrates moderate left ventricular dysfunction (Ejection Fraction (EF) 40%) with akinesia of all apical segments, mild aortic regurgitation, and normal right-sided chambers. The diagnostic work-up proceeds with coronary angiography, which identifies critical stenosis in the mid-segment of the left anterior descending artery (LAD), successfully treated with angioplasty and stent placement. Moderate stenosis persists in the mid-segment of the circumflex artery and the right coronary artery. Four days later, a follow-up transthoracic echocardiogram revealed improvement in left ventricular kinetics, with residual hypokinesis confined to the apical segments. On the suspicion of Takotsubo syndrome (TTS), a cardiac magnetic resonance imaging (MRI) was therefore performed, showing recovery of global left ventricular contractility but with a slight increase in T2 signal in the apical segments (T2 58 msec, normal range 50 ± 3), indicating mild residual edema due to the recent TTS without an ischemic pattern. The MRI also identified a concomitant hypertrophic phenotype, with a mean septal thickness of 17 mm, and late gadolinium enhancement in an inferolateral basal intramyocardial distribution, suggesting a dual cardiomyopathy with coexisting coronary artery disease. The patient was discharged with a prescription for dual antiplatelet therapy, including Cardioaspirin and Prasugrel, to be continued for 12 months in consideration of the recent angioplasty. Therapy was optimized with the addition of statins and adjustments to the patient’s oral antidiabetic regimen. A follow-up was scheduled in three months for a cardiology visit and repeat echocardiogram, with a cardiac MRI planned at six months to evaluate left ventricular function and tissue characteristics