This review article by Giancarlo Trimarchi et al. discusses transient left ventricular dysfunction (TLVD), a condition characterized by reversible impairment of ventricular function. TLVD is often underdiagnosed and can be caused by a wide range of conditions, including stress-induced cardiomyopathy, central nervous system injuries, histaminergic syndromes, inflammatory diseases, pregnancy-related conditions, and genetically determined syndromes. The article highlights the importance of differentiating between these causes due to distinct clinical, instrumental, and genetic predictors that influence the prognosis and recovery potential of left ventricular function. The review covers various clinical scenarios, such as Tako-Tsubo Syndrome (TTS), Kounis syndrome, myocarditis, peripartum cardiomyopathy (PPCM), and tachycardia-induced cardiomyopathy (TIC). Each condition is discussed in detail, including its pathophysiology, diagnostic criteria, and predictors of ventricular recovery and outcomes. Key findings include: - **Tako-Tsubo Syndrome (TTS)**: Characterized by regional wall motion abnormalities, TTS is often associated with catecholamine excess and microvascular dysfunction. predictors of recovery include age, physical stress, and non-typical ballooning patterns. - **Neurogenic Stunned Myocardium**: Caused by acute neurological injuries, this condition is linked to catecholamine distress and can lead to severe cardiac dysfunction. Recovery is typically anticipated but influenced by neurological severity. - **Kounis Syndrome**: An allergic reaction causing coronary vasospasm, Kounis syndrome can lead to TLVD. Recovery depends on the extent of the primary reaction and the presence of additional pathologies. - **Myocarditis**: Inflammation of the heart muscle, myocarditis can result from infections or autoimmune disorders. Recovery is unpredictable and influenced by initial symptoms, inflammation, and the use of beta-blockers. - **Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA)**: Caused by various non-atherosclerotic factors, MINOCA can lead to significant left ventricular dysfunction but often shows spontaneous recovery. predictors of adverse outcomes include age, smoking, diabetes, and elevated biomarkers. - **Peripartum Cardiomyopathy (PPCM)**: A condition affecting pregnant women, PPCM is often linked to genetic predispositions and inflammation. Recovery is generally good but influenced by initial LVEF, ethnicity, and biomarker levels. - **Tachycardia-Induced Cardiomyopathy (TIC)**: Caused by arrhythmias, TIC can lead to temporary or permanent heart dysfunction. predictors of recovery include lower age at presentation and higher LVEF. The article also discusses the role of imaging techniques like cardiac magnetic resonance (CMR) in diagnosing and monitoring myocardial viability, particularly in conditions like hibernating myocardium and stunned myocardThis review article by Giancarlo Trimarchi et al. discusses transient left ventricular dysfunction (TLVD), a condition characterized by reversible impairment of ventricular function. TLVD is often underdiagnosed and can be caused by a wide range of conditions, including stress-induced cardiomyopathy, central nervous system injuries, histaminergic syndromes, inflammatory diseases, pregnancy-related conditions, and genetically determined syndromes. The article highlights the importance of differentiating between these causes due to distinct clinical, instrumental, and genetic predictors that influence the prognosis and recovery potential of left ventricular function. The review covers various clinical scenarios, such as Tako-Tsubo Syndrome (TTS), Kounis syndrome, myocarditis, peripartum cardiomyopathy (PPCM), and tachycardia-induced cardiomyopathy (TIC). Each condition is discussed in detail, including its pathophysiology, diagnostic criteria, and predictors of ventricular recovery and outcomes. Key findings include: - **Tako-Tsubo Syndrome (TTS)**: Characterized by regional wall motion abnormalities, TTS is often associated with catecholamine excess and microvascular dysfunction. predictors of recovery include age, physical stress, and non-typical ballooning patterns. - **Neurogenic Stunned Myocardium**: Caused by acute neurological injuries, this condition is linked to catecholamine distress and can lead to severe cardiac dysfunction. Recovery is typically anticipated but influenced by neurological severity. - **Kounis Syndrome**: An allergic reaction causing coronary vasospasm, Kounis syndrome can lead to TLVD. Recovery depends on the extent of the primary reaction and the presence of additional pathologies. - **Myocarditis**: Inflammation of the heart muscle, myocarditis can result from infections or autoimmune disorders. Recovery is unpredictable and influenced by initial symptoms, inflammation, and the use of beta-blockers. - **Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA)**: Caused by various non-atherosclerotic factors, MINOCA can lead to significant left ventricular dysfunction but often shows spontaneous recovery. predictors of adverse outcomes include age, smoking, diabetes, and elevated biomarkers. - **Peripartum Cardiomyopathy (PPCM)**: A condition affecting pregnant women, PPCM is often linked to genetic predispositions and inflammation. Recovery is generally good but influenced by initial LVEF, ethnicity, and biomarker levels. - **Tachycardia-Induced Cardiomyopathy (TIC)**: Caused by arrhythmias, TIC can lead to temporary or permanent heart dysfunction. predictors of recovery include lower age at presentation and higher LVEF. The article also discusses the role of imaging techniques like cardiac magnetic resonance (CMR) in diagnosing and monitoring myocardial viability, particularly in conditions like hibernating myocardium and stunned myocard