Key result
Takotsubo syndrome requires multimodal diagnosis and phenotype-guided management across heterogeneous brain-heart presentations.
Why the study?
Takotsubo syndrome is a heterogeneous acute heart failure syndrome with complex brain–heart axis mechanisms and lacks phenotype-guided diagnostic and management frameworks.
Takotsubo syndrome should be recognized and managed as a heterogeneous acute heart failure syndrome requiring mechanism-aware, phenotype-guided individualized care rather than a purely exclusion-based, benign condition.
Supports phenotype-guided Takotsubo management; leaves open prospective validation of multimodal algorithms before practice change.
More and more evidence suggests that Takotsubo syndrome (TTS) is not a one-size-fits-all benign self-limiting condition, but a highly heterogeneous acute heart failure syndrome. Most existing reviews are largely descriptive and fail to truly link brain–heart axis mechanisms, diagnostic refinement, and phenotype-guided care. This review focuses on recent advances since 2019, with emphasis on autonomic imbalance, neurocardiac vulnerability, multimodal imaging, Mayo and InterTAK diagnostic frameworks, and emerging contexts such as COVID-19, immune checkpoint inhibitors, and spontaneous coronary artery dissection. Current evidence points to sympathetic activation, insufficient parasympathetic regulation, coronary microvascular dysfunction, and inflammatory–immune responses jointly contributing to reversible myocardial stunning. Diagnosis cannot rely solely on ruling out obstructive coronary artery disease, because TTS can coexist with coronary artery disease, acute coronary syndrome (ACS), or SCAD. CMR and, in selected stable patients, CCTA provide useful complementary information for differential diagnosis and risk assessment. Management remains largely supportive, but stratifying patients according to hemodynamic status, left ventricular outflow tract obstruction, arrhythmic and thromboembolic risks, trigger context, and extracardiac comorbidities can make acute and long-term care more individualized. Finally, we propose a phenotype-guided clinical framework and highlight priorities for future prospective studies.
No takes yet. Share an insight, caveat, or question.
Dai et al. (2026) conducted a review in Takotsubo syndrome. Takotsubo syndrome is a highly heterogeneous acute heart failure syndrome driven by brain-heart axis mechanisms, requiring integrated multimodal diagnosis and phenotype-guided individualized management.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: