More positive strain compared with myocardial infarction (TC -11%, ACS -14%)

Segmental strain ratio (SSR) can be calculated (b = basal) 

‣(B. inf.+ b. inferolateral) / (b. ant. + b. anteroseptal + mid ant. + mid anteroseptal) = >1,58 (specificity 90%, sensitivity 75% for LAD infarction)

TakoTsubo is more likely to have hyperdynamic basal segments compared to a large LAD infarction

But it is not always accurate! Here, SSR >1,58 in bland coronary angiography in TakoTsubo syndrome

DD large myocardial infarction with more than 1 coronary artery involved

Addendum: Mental stress-induced myocardial ischemia — GLS worsening under emotional stress