Role of Coronary Microvascular Dysfunction in Takotsubo Cardiomyopathy

Takotsubo cardiomyopathy (TTC) is a relatively frequent acute cardiac condition, but its pathogenesis has not been established as yet. Since the first descriptions of TTC, microvascular dysfunction has been advocated as a possible pathophysiological mechanism underlying the left ventricular wall motion abnormalities that characterize the syndrome. Several noninvasive and invasive methods have confirmed the involvement of coronary microvascular abnormalities in the pathogenesis of TTC, but whether microvascular dysfunction is the primary cause or a secondary phenomenon is still debated. The greater prevalence of TTC among postmenopausal women, along with the relationship identified between physical and emotional triggers and other "neuro-cardiac" mechanisms, suggest that increased microvascular reactivity, possibly sympathetically mediated, may play a pathogenic role in susceptible individuals. This review critically evaluates the possible role of microvascular dysfunction in the development of TTC.