Takotsubo Syndrome Therapy: Current Status and Future Directions

Tako-Tsubo Cardiomyopathy (TTC), which is now known as Tako-Tsubo Syndrome (TTS) is a transient left ventricular (LV) systolic dysfunction of uncertain pathogenesis, which occurs predominantly in ageing women. There is considerable uncertainty regarding the management of TTS related acute and chronic issues and most of the evidence regarding therapy comes from retrospective data and case studies. In this review we have tried to concise the available information on the TTS therapeutics to help clinicians make treatment decisions in patients diagnosed with TTS. At the same time we have highlighted some of the uncertainties regarding TTS therapy, in particular the inability of b-blocker therapy to improve survival or prevent recurrence. We have also emphasized the issue of incomplete recovery in some cases of TTS where there is ongoing inflammation and evidence of impaired myocardial energetics despite normalization of LV ejection fraction. Although there is no scientific evidence on how to improve or fasten the recovery of TTS, we believe therapy improving energy efficiency may play some role in future. Lastly, we would like to reiterate that in the absence of randomized studies evaluating medical therapy in TTS, the treatment for this syndrome remains entirely empirical and should be individualized according to the patient characteristics at the time of presentation.