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In this study, we investigated the effects of the catecholamine dobutamine on non-invasive CFR in TSC. Our hypothesis was that CFR is reduced during dobutamine find more stress in patients with a previous episode of TSC. Methods Study group Twenty-two patients with a previous episode of TSC and 22 sex-matched and age-matched controls were recruited from the Stockholm Myocardial Infarction with Normal Coronaries study. The patients with TSC fulfilled the Mayo Clinic criteria for TSC.9 All patients with TSC were investigated with dobutamine stress tests focusing on non-invasive CFR, performed more than 6?months after the acute event. All patients with TSC were previously investigated with cardiovascular MR (CMR) and found to have no signs of previous myocardial infarction (myocardial necrosis) or myocarditis. The controls were sex-matched and age-matched volunteers recruited from the Stockholm metropolitan area. The controls were not investigated with coronary angiography prior to this study but had no signs or symptoms of coronary artery disease and a normal exercise stress test prior to inclusion into the study. Treatment with ��-blockers was withheld on the day before examination. Current smokers were asked not to smoke on the day of examination. CFR All patients and controls were investigated before and during dobutamine stress. A Philips (Amsterdam, The Netherlands) iE33 was used to obtain echocardiograms. First the left ventricular (LV) ejection fraction (EF) and function of the mitral, tricuspid and aortic valve were recorded. For the flow velocity recordings a 3.5?MHz high-frequency probe was used. The filter settings were kept at 150?Hz and gains were adjusted to the lowest possible level to minimise noise. A 10?mm sample volume was used. A Doppler velocity range of ?15 to 15?cm/s was selected but modified according to the maximum flow velocity achieved during increasing dobutamine levels. At rest, the flow velocity curve of the left anterior descending (LAD) artery was assessed from an apical two-chamber view (figure 1). If necessary, SonoVue (Bracco, Milano, Italy) contrast was used to enhance the flow velocity signal. The images obtained with Doppler were analysed using Syngo Dynamics software (Siemens Healthcare, Erlangen, Germany). Figure?1 Assessing the flow velocity curve in the left anterior descending artery (TSC, Takotsubo stress cardiomyopathy). Dobutamine stress The dobutamine stress examination was performed approximately 1?year and 8?months (mean 619��297?days) after the acute event for the TSC group and according to the consensus statement of the European Association of Echocardiography.