Takotsubo Syndrome: Pathophysiology, Emerging Concepts, and Clinical Implications

Trisha Singh*, Hilal Khan, David T. Gamble, Caroline Scally, David E. Newby, Dana Dawson

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Citations (Scopus)

Abstract

Takotsubo syndrome is a condition characterized by acute transient left ventricular systolic dysfunction, which at presentation can be challenging to distinguish from acute myocardial infarction. Although previously thought to be a benign, self-limiting condition, recent studies have confirmed that patients with takotsubo syndrome have persistent subtle ongoing cardiac dysfunction, and many continue to have limiting symptoms despite restoration of left ventricular ejection fraction. Moreover, these patients have a substantial burden of morbidity and mortality, as well, with high rates of subsequent major adverse cardiovascular events that approach those of patients with acute coronary syndrome. The mechanisms behind this condition remain elusive. Despite substantial research, the medical community continues to have an incomplete understanding of its underlying pathogenesis and pathophysiology. Catecholamine-induced myocardial injury is the most established and well-known theory, but this does not explain all the clinical features and presentations of the condition, and numerous other pathways and abnormalities are emerging. Because of the poor understanding of its underlying pathophysiology, there is a lack of evidence-based interventions to treat the acute episode, to avoid recurrences, and to prevent major adverse cardiovascular events. This highlights the need for further research to gain a better understanding of the underlying pathophysiology to inform appropriate randomized controlled trials of interventions targeting the causative pathways. Only then can evidence-based management strategies be established to improve clinical outcomes of this potentially lethal condition.

Original languageEnglish
Pages (from-to)1002-1019
Number of pages18
JournalCirculation
Volume145
Issue number13
Early online date28 Mar 2022
DOIs
Publication statusPublished - 29 Mar 2022

Keywords

  • physiopathology
  • Takotsubo cardiomyopathy
  • treatment outcomes
  • TAKO-TSUBO CARDIOMYOPATHY
  • ACUTE CORONARY SYNDROME
  • IN-HOSPITAL MORTALITY
  • ST-SEGMENT ELEVATION
  • STRESS CARDIOMYOPATHY
  • HEART-FAILURE
  • AGE
  • FEATURES
  • OUTCOMES
  • ABNORMALITIES

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