Martínez-Sellés Manuel
Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, 28007 Madrid, Spain.
School of Biomedical and Health Sciences, Universidad Europea, 28670 Madrid, Spain.
Rev Cardiovasc Med. 2025 Aug 29;26(8):39562. doi: 10.31083/RCM39562. eCollection 2025 Aug.
Stress cardiomyopathy/Takotsubo syndrome (TTS) is a transient cardiac condition characterized by sudden and reversible left ventricular dysfunction, typically triggered by emotional or physical stress. The international TTS (InterTAK) score predicts the probability of suffering from TTS. However, the diagnostic algorithm includes three mutually exclusive diagnoses: acute coronary syndrome (ACS), TTS, and acute infectious myocarditis. Thus, we propose to include the conditions in which TTS is associated with ACS or myocarditis. While TTS is commonly associated with non-ischemic stressors, recent evidence has indicated that TTS can be found in patients with ACS. Nonetheless, in some cases, ACS may trigger rather than exclude TTS. Additionally, TTS could also prompt plaque ruptures in coronary arteries. Meanwhile, infections and conditions that cause myocarditis can also produce physical stress that may trigger TTS. Furthermore, TTS has been reported after confirmed viral myocarditis. This opinion article explores the intricate relationships between (i) TTS and ACS, and (ii) TTS and myocarditis, delving into the related pathophysiologies and diagnostic challenges. However, further research is required to elucidate the mechanisms that link TTS with these conditions.
应激性心肌病/ Takotsubo综合征（TTS）是一种短暂的心脏疾病，其特征是左心室功能突然出现可逆性障碍，通常由情绪或身体应激引发。国际TTS（InterTAK）评分可预测患TTS的概率。然而，诊断算法包括三种相互排斥的诊断：急性冠状动脉综合征（ACS）、TTS和急性感染性心肌炎。因此，我们建议纳入TTS与ACS或心肌炎相关的情况。虽然TTS通常与非缺血性应激源相关，但最近的证据表明，ACS患者中也可发现TTS。尽管如此，在某些情况下，ACS可能引发而非排除TTS。此外，TTS也可能促使冠状动脉斑块破裂。同时，感染及导致心肌炎的病症也可产生可能引发TTS的身体应激。此外，确诊病毒性心肌炎后也有TTS的报道。这篇观点文章探讨了（i）TTS与ACS之间以及（ii）TTS与心肌炎之间的复杂关系，深入研究了相关的病理生理学和诊断挑战。然而，需要进一步研究以阐明将TTS与这些病症联系起来的机制。
