Microvascular dysfunction in Takotsubo syndrome has a variable prevalence (35% to 100%) and is associated with higher systolic impairment, major cardiovascular events, and long-term mortality.
Systematic Review
What is the prevalence of microvascular dysfunction in Takotsubo syndrome and is it associated with clinical outcomes?
Microvascular dysfunction in Takotsubo syndrome has a highly variable prevalence and is associated with worse systolic impairment and long-term clinical outcomes, though it may not be a prerequisite for disease onset.
BACKGROUND: Microvascular dysfunction (MD) is advocated as one of the main pathogenic mechanisms of Takotsubo syndrome (TTS). Several studies investigated MD in TTS using different techniques; however, no systematic review of these data is currently available. METHODS: We searched the main scientific database (Embase, Medline, Scopus, PubMed) for articles written in English language using the following keywords: ('takotsubo' OR 'broken heart' OR 'apical ballooning' OR 'stress cardiomyopathy') AND ('microvascular'). Case reports: studies not performed in human subjects or investigating microvascular function in organs other than the heart were excluded. RESULTS: = 2, with some studies applying more than 1 technique. When established cutoff values were used, MD prevalence largely varied (35% to 100%). Although comprehensive clinical correlates were scarcely reported, MD was consistently associated with higher systolic impairment. Blood-based inflammatory biomarkers analysis was performed in one study only, providing inconclusive results. Clinical outcomes associated with MD were reported in four studies including higher rates of major cardiovascular events and long-term mortality. CONCLUSIONS: MD in TTS has a variable prevalence. It is absent in a relevant proportion of the cases, making it questionable as it should be considered a pre-requisite for disease onset. The presence and extent of MD in TTS is a promising prognostic marker; no data in humans currently confirm its role as a therapeutic target.
Arcari et al. (Fri,) conducted a systematic review in Takotsubo syndrome. Microvascular dysfunction was evaluated on Prevalence of microvascular dysfunction and associated clinical outcomes. Microvascular dysfunction in Takotsubo syndrome has a variable prevalence (35% to 100%) and is associated with higher systolic impairment, major cardiovascular events, and long-term mortality.