Key result
Coronary microvascular dysfunction in Takotsubo syndrome linked to transient LV dysfunction and higher mortality.
Why the study?
Although Takotsubo syndrome mimics acute coronary syndrome, its underlying mechanisms remain incompletely understood, with recent evidence highlighting coronary microvascular dysfunction as a key contributor.
This narrative review highlights the pivotal role of coronary microvascular dysfunction in the pathophysiology, clinical presentation, and prognosis of Takotsubo syndrome.
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Supports CMD assessment for risk stratification in Takotsubo; leaves open benefit of targeted therapies pending dedicated trials.
Takotsubo syndrome (TTS) is an acute and reversible form of heart failure characterised by transient left ventricular (LV) dysfunction in the absence of obstructive coronary artery disease and often triggered by emotional or physical stress. Although the clinical presentation may mimic acute coronary syndrome, the underlying mechanisms remain incompletely understood. Recent evidence highlights coronary microvascular dysfunction (CMD) as a key factor contributing to myocardial ischaemia and transient LV dysfunction in TTS.CMD in TTS appears multifactorial, involving autonomic dysregulation, endothelial dysfunction, inflammation and myocardial oedema, all contributing to transient impairment of myocardial perfusion. Invasive studies consistently demonstrate elevated microvascular resistance and reduced coronary flow reserve during the acute phase, with gradual recovery and improvement in LV function. CMD in TTS has also been associated with adverse prognosis, including higher mortality and persistent LV dysfunction.This narrative review summarises current evidence supporting the pivotal role of CMD in the pathophysiology and prognosis of TTS. We discuss the invasive and non-invasive techniques used to assess CMD, explore the neuro-immune-cardiac interplay underlying TTS and discuss ongoing clinical trials that may refine future diagnostic and therapeutic strategies targeting CMD in TTS.
Yosofi et al. (2026) studied this question. Coronary microvascular dysfunction in Takotsubo syndrome contributes to transient left ventricular dysfunction and is associated with an adverse prognosis, including higher mortality.
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