Takotsubo Syndrome: Clinical Features, Pathogenesis, Treatment, and Relationship with Cerebrovascular Diseases
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Purpose of Review
This review paper aims to provide a complete and updated overview on the clinical and pathophysiological aspects of Takotsubo syndrome (TTS), including prognosis, therapy, and the association with cerebrovascular conditions.
TTS is an increasingly recognized non-ischemic cardiomyopathy characterized by sudden, temporary weakening of the myocardium, of which the pathogenesis is unknown.
Although pathogenesis of TTS remains unclear, a complex interaction between catecholamine-mediated stimulation, myocardial stunning, and subsequent stress-related myocardial dysfunction seems to be the main pathophysiological mechanism. Stroke is linked to TTS by a dual relationship since it may induce TTS by catecholamine release even if TTS itself also may be complicated by left ventricular thrombi leading to stroke. Given its possible complications, including the association with neurological diseases, both cardiologist and neurologists should be aware about TTS in order to diagnose it promptly and to initiate appropriate therapeutic measures.
KeywordsDiagnosis Ischemic stroke Subarachnoid hemorrhage Pathogenesis Takotsubo syndrome Therapy
All the authors contributed to drafting the article or revising it critically for important intellectual content and finally approved the last version to be published.
Compliance with Ethical Standards
Conflict of Interest
Ranieri M., Finsterer J., Bedini G., Parati E.A., and Bersano A. declare no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 2.Maron BJ, Towbin JA, Thiene G, Antzelevitch C, Corrado D, Arnett D, et al. Contemporary definitions and classification of the cardiomyopathies: an American Heart Association scientific statement from the council on clinical cardiology, heart failure and transplantation committee; quality of care and outcomes research and functional genomics and translational biology interdisciplinary working groups; and council on epidemiology and prevention. Circulation. 2006;113:1807–16.PubMedGoogle Scholar
- 5.Eshmukh A, Kumar G, Pant S, Rihal C, Murugiah K, Mehta JL. Prevalence of takotsubo cardiomyopathy in the United States. Am Heart J. 2012;164:66–71.Google Scholar
- 6.Nascimento FO, Larrauri-Reyes MC, Santana O, Pérez-Caminero M, Lamas GA. Comparison of stress cardiomyopathy in Hispanic and non-Hispanic patients. Rev Esp Cardiol (Engl Ed). 2013;66:67–8.Google Scholar
- 10.•• Lyon AR, Bossone E, Schneider B, Sechtem U, Citro R, Underwood SR, et al. Current state of knowledge on takotsubo syndrome: a position statement from the taskforce on takotsubo syndrome of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2016;18(1):8–27. The paper reports the position statement from the European Society of cardiology Failure Association providing a comprehensive review on pathophysiology, complications, prognosis and providing new algorythms for diagnosis and decision making in TTS patients. PubMedGoogle Scholar
- 18.Cacciotti L, Camastra GS, Beni S, Giannantoni P, Musaro S, Proietti I, et al. A new variant of Tako-tsubo cardiomyopathy: transient mid-ventricular ballooning. J Cardiovasc Med. 2007;8:1052–4.Google Scholar
- 21.• Frangieh AH, Obeid S, Ghadri JR, Imori Y, D'Ascenzo F, Kovac M, et al. ECG criteria to differentiate between takotsubo (stress) cardiomyopathy and myocardial infarction. J Am Heart Assoc. 2016;5(6):e003418. The paper comparing 200 subjects with TTS and Myocardial incarction highlight the role of ECG on admission in differentiating between TTC and acute MI, with high specificity and positive predictive value. PubMedPubMedCentralGoogle Scholar
- 29.Randhawa MS, Dhillon AS, Taylor HC, Sun Z, Desai MY. Diagnostic utility of cardiac biomarkers in discriminating takotsubo cardiomyopathy from acute myocardial infarction. J Card Fail. 2014;2:2–8.Google Scholar
- 32.•• Y-Hassan S, Tornvall P. Epidemiology, pathogenesis, and management of takotsubo syndrome. Clin Auton Res. 2017. Comprehensive and very recent review on pathophysiological and management aspects of TTS. Google Scholar
- 35.Ueyama T, Yamamoto Y, Ueda K, Kawabe T, Hano T, Ito T, et al. Cardiac and vascular gene profiles in an animal model of takotsubo cardiomyopathy. Heart Vessel. 2011;26:321–37.Google Scholar
- 67.Kim SM, Aikat S, Bailey A, White M. Takotsubo cardiomyopathy as a source of cardioembolic cerebral infarction. BMJ Case Rep. 2012;21:2012.Google Scholar
- 80.Devos J, Peeters A, Wittebole X, Hantson P. High-dose insulin therapy for neurogenic-stunned myocardium after stroke. BMJ Case Rep. 2012;21:2012.Google Scholar
- 85.Y-Hassan S, Winter R, Henareh L. The causality quandary in a patient with stroke, takotsubo syndrome and severe coronary artery disease. J Cardiovasc Med. 2015;16:S118–21.Google Scholar
- 104.• Ghadri JR, Cammann VL, Templin C. The international takotsubo registry: rationale, design, objectives, and first results. Heart Fail Clin. 2016;12(4):597–603. Interesting paper reporting the major goals of the International Takotsubo Registry (InterTAK Registry) aimed at providing a comprehensive clinical characterization on natural history, treatment, and outcomes. PubMedGoogle Scholar