Key result
Takotsubo syndrome shares pathophysiological mechanisms with CMD and exhibits a complex relationship with CAD.
Why the study?
Despite growing recognition of Takotsubo syndrome, an evidence gap persists in its diagnosis, complicated by its classification within MINOCA, coexistence with CAD, and shared pathophysiological mechanisms with ANOCA and INOCA.
Design
Review
Supports diagnostic caution amid CAD overlap in Takotsubo syndrome; leaves open mechanism-targeted trials.
Takotsubo syndrome (TTS) is an acute, reversible form of left ventricular dysfunction, typically triggered by emotional or physical stress. The hallmark feature is reversible regional wall motion abnormality extending beyond a single coronary distribution, most commonly presenting with an apical ballooning pattern. The pathophysiology is multifactorial, encompassing neurohormonal dysregulation, catecholamine-mediated toxicity, microvascular dysfunction, oxidative stress, inflammation, and metabolic disturbances. Nonetheless, despite growing recognition, an evidence gap persists in diagnosing TTS. Meanwhile, TTS is classified within myocardial infarction with non-obstructive coronary arteries (MINOCAs) and frequently treated as a diagnosis of exclusion. Further complicating the diagnostic algorithm, emerging evidence indicates that TTS and coronary artery disease (CAD) may coexist, suggesting a potential bidirectional relationship rather than a bystander phenomenon. Moreover, TTS shares several pathophysiological mechanisms with coronary microvascular dysfunction syndromes: angina with non-obstructive coronary arteries (ANOCAs) and ischemia with non-obstructive coronary arteries (INOCAs). These overlaps underscore the need for rigorous differential diagnosis and careful comprehensive evaluation of hemodynamic significance, plaque morphology, and microvascular phenotyping to enhance clinical recognition and optimize therapeutic decision-making. This review synthesizes current evidence on the diagnosis and management of TTS, emphasizing the intersection between TTS and coronary and microvascular disorders to promote a more targeted, mechanism-based therapeutic approach.
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Rossi et al. (2025) studied this question. Takotsubo syndrome exhibits a complex relationship with coronary artery disease and shares pathophysiological mechanisms with coronary microvascular dysfunction syndromes.
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