New aspects in the diagnosis of takotsubo syndrome

In recent years, there has been increased interest among researchers in the study of Takotsubo syndrome (TS), a special form of reversible left ventricle myocardial dysfunction and, in rare cases, right ventricle dysfunction. It is known that this condition predominantly affects postmenopausal women and is often triggered by physical or emotional stress. However, the pathophysiology of TS remains incompletely understood, with current evidence highlighting the role of catecholamine surge and sympathetic nervous system activation. Given that TS is similar to acute coronary syndrome in terms of clinical and electrocardiographic findings, as well as cardiac biomarker profiles, differential diagnosis between these two conditions is a task enquiring careful clinical judgment. Moreover, despite the reversible nature of TS, it is associated with a high risk of both in-hospital and long-term complications. Echocardiography is the main imaging method to detect the characteristic form of left ventricular akinesia or dyskinesia and to exclude other causes of acute heart failure. Nevertheless, coronary angiography, in which the key sign is the absence of obstructive lesions of coronary arteries, and cardiac magnetic resonance imaging, which assesses myocardial edema, fibrosis, and other structural changes, are of great importance in the TS diagnosis. Thus, a multimodal imagining approach significantly increases diagnostic accuracy and enables timely prognosis assessment in patients. The purpose of this review is to provide up-to-date information on the etiology and clinical features of TS, as well as to discuss current perspectives on its diagnosis.