Recent Advancements and Persistent Challenges in the Management of Patients with Takotsubo Syndrome

Abstract

I Leontsinis, E Mantzouranis, A Sakalidis, I Ntalakouras, I Dri, S Soulaidopoulos, P Vlachakis, M Palkopoulou, C Fragkoulis, A Kasiakogias and K Tsioufis

Background: Takotsubo Syndrome (TTS) is an increasingly recognized condition, initially perceived as benign, but now associated with considerable morbidity and mortality. Its pathophysiology remains elusive and despite advancements in understanding, management strategies remain inconsistent and lack support from randomized clinical trials.

Aims: This review aims to consolidate current evidence on the pathophysiology, diagnostic algorithms, treatment approaches, and prognosis of TTS, while highlighting the ongoing debates and challenges in its management.

Methods: A comprehensive review of recent literature was conducted, focusing on key studies, registries, and consensus guidelines.

Results: TTS is predominantly observed in postmenopausal women and is often triggered by emotional or physical stressors. The pathophysiology likely involves catecholamine surges, microvascular dysfunction, and inflammation. Diagnosis relies on imaging modalities like echocardiography and cardiac MRI, with the InterTAK criteria being the most widely accepted. Acute management focuses on stabilizing patients based on hemodynamic status, avoiding harmful interventions, and carefully selecting pharmacotherapy, despite mixed evidence for long-term benefit. Prognosis varies significantly, with worse outcomes associated with physical stress triggers, male gender, and comorbidities. Recurrence rates remain low but concerning, with inconsistent data regarding the effectiveness of the neuro-hormonal blockade medications and other therapies in preventing recurrence.

Conclusion: TTS poses significant clinical challenges due to its variable prognosis and lack of standardized treatment. Current management is largely symptomatic and supportive, with decisions tailored to individual risk profiles.

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