Tako-Tsubo Cardiomyopathy: A Heart Stressed Out of Energy?

Tako-tsubo cardiomyopathy (TTC) is an acute form of left ventricular (LV) systolic dysfunction often following intense stress, but its pathophysiology remains elusive. Because of its reversible natural course without much apparent myocyte damage, as inferred by the lack of late gadolinium-enhanced (LGE) cardiac magnetic resonance (CMR), it has been a priori assumed that its evolution is benign (1). Whatever the etiology of the acute insult, it is important to establish the nature of this state of intense myocardial contractile dysfunction with preserved viability, as this may point to a potential therapeutic target in those cases with a less favorable clinical course. It is known that impaired cardiac energetic status is directly linked to clinical and subclinical LV dysfunction. We hypothesized that impaired cardiac energetics may occur in acute TTC, further investigating its recovery at 4 months follow-up.