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Takotsubo pathophysiology and complications: what we know and what we do not know

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Abstract

Takotsubo cardiomyopathy or stress cardiomyopathy (SCM), was first described in 1990 and initially, it was thought to be only associated with short-term complications and mortality with a benign long-term prognosis comparable to a healthy population. However recent investigations have proven otherwise and have shown SCM patients might have comparable long-term morbidity and mortality to ST-elevation myocardial infarction (STEMI) patients. Many emotional, or physical stressors can trigger SCM, and have been able to describe an interplay of neurohormonal and inflammatory mechanisms as the pathophysiology of this disease. Additionally, given the significantly higher prevalence of SCM in post-menopausal women, estrogen levels have been thought to play a role in the pathogenesis of this disease. Furthermore, there is an elusive disparity in prognosis depending upon different triggers. Currently, many questions remain unanswered regarding the long-term management of these patients to reduce morbidity, mortality, and improve quality of life, such as the need for long-term anticoagulation. In this paper, we review the findings of most recent published investigations regarding etiologies, pathophysiology, diagnostic criteria, prognosis, short-term and in more detail, long-term complications of SCM. Finally, we will discuss what future research is needed to learn more about this disease to improve the long-term prognosis, even though as of now, data for long-term management is still lacking.

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Fig. 1
Fig. 2

Source: Citro R, Okura H, Ghadri JR, Izumi C, Meimoun P, Izumo M, Dawson D, Kaji S, Eitel I, Kagiyama N, Kobayashi Y, Templin C, Delgado V, Nakatani S, Popescu BA; EACVI Scientific Documents Committee. Multimodality imaging in takotsubo syndrome: a joint consensus document of the European Association of Cardiovascular Imaging (EACVI) and the Japanese Society of Echocardiography (JSE). Eur Heart J Cardiovasc Imaging. 2020 Oct 20;21(11):1184–1207

Fig. 3

Source: Citro R, Okura H, Ghadri JR, Izumi C, Meimoun P, Izumo M, Dawson D, Kaji S, Eitel I, Kagiyama N, Kobayashi Y, Templin C, Delgado V, Nakatani S, Popescu BA; EACVI Scientific Documents Committee. Multimodality imaging in takotsubo syndrome: a joint consensus document of the European Association of Cardiovascular Imaging (EACVI) and the Japanese Society of Echocardiography (JSE). Eur Heart J Cardiovasc Imaging. 2020 Oct 20;21(11):1184–1207

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Authors and Affiliations

  1. Internal Medicine, Wright State University, 128 E. Apple St., 2Nd Floor, Dayton, OH, 45409, USA

    Mehdi Shadmand, Jacob Lautze & Ali Mehdirad MD

  2. Medical Center, Internal Medicine, Veteran Affairs (VA), 4100 W Third St., Dayton, OH, 45428, USA

    Ali Mehdirad MD

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All authors were involved in the literature review. Dr. Shadmand was the primary writer of this manuscript. Dr. Lautze was involved in writing a section on epidemiology and introduction. Dr. Mehdirad was also extensively involved in reviewing the article and providing insight on the arrhythmia section.

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Correspondence to Mehdi Shadmand.

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Shadmand, M., Lautze, J. & MD, A.M. Takotsubo pathophysiology and complications: what we know and what we do not know. Heart Fail Rev 29, 497–510 (2024). https://doi.org/10.1007/s10741-023-10381-8

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