Schino Sofia, Bezzeccheri Andrea, Russo Alessandro, Bonanni Michela, Cosma Joseph, Sangiorgi Giuseppe, Chiricolo Gaetano, Martuscelli Eugenio, Santoro Francesco, Mariano Enrica Giuliana
Department of Cardiovascular Medicine, University of Rome "Tor Vergata'', 00133 Rome, Italy.
Department of Biomedicine and Prevention, University of Rome "Tor Vergata'', 00133 Rome, Italy.
Rev Cardiovasc Med. 2023 Jan 10;24(1):19. doi: 10.31083/j.rcm2401019. eCollection 2023 Jan.
An acute, transient episode of left ventricular dysfunction characterizes Takotsubo syndrome. It represents about 2% of all cases of acute coronary syndrome (ACS), and occurs predominantly in postmenopausal women, generally following a significant physical or emotional stressor. It can be diagnosed based on clinical symptoms and the absence of coronary artery disease on angiography. Ventriculography remains the gold standard for the diagnosis. Despite its transitory characteristic Takotsubo syndrome should not be considered a benign condition since complications occur in almost half of the patients, and the mortality rate reaches 4-5%. Lately, it has been revealed that Takotsubo syndrome can also lead to permanent myocardial damage due to the massive release of catecholamines that leads to myocardial dysfunction. Different mechanisms have been advanced to explain this fascinating syndrome, such as plaque rupture and thrombosis, coronary spasm, microcirculatory dysfunction, catecholamine toxicity, and activation of myocardial survival pathways. Here are still several issues with Takotsubo syndrome that need to be investigated: the complex relationship between the heart and the brain, the risk of permanent myocardial damage, and the impairment of cardiomyocyte. Our review aims to elucidate the pathophysiology and the mechanisms underlying this complex disease to manage the diagnostic and therapeutic algorithms to create a functional synergy between physicians and patients.
Takotsubo综合征的特征是急性、短暂性左心室功能障碍。它约占急性冠状动脉综合征（ACS）所有病例的2%，主要发生在绝经后女性中，通常在经历重大身体或情绪应激源之后。可根据临床症状及血管造影显示无冠状动脉疾病来进行诊断。心室造影仍是诊断的金标准。尽管Takotsubo综合征具有短暂性特征，但不应将其视为良性疾病，因为几乎一半的患者会出现并发症，死亡率达4% - 5%。最近发现，Takotsubo综合征还可因儿茶酚胺大量释放导致心肌功能障碍而引起永久性心肌损伤。人们提出了不同机制来解释这一迷人的综合征，如斑块破裂与血栓形成、冠状动脉痉挛、微循环功能障碍、儿茶酚胺毒性以及心肌存活途径的激活。Takotsubo综合征仍存在几个有待研究的问题：心脏与大脑之间的复杂关系、永久性心肌损伤的风险以及心肌细胞的损伤。我们的综述旨在阐明这种复杂疾病的病理生理学及潜在机制，以管理诊断和治疗方案，在医生和患者之间建立起有效的协同关系。
