Kosek-Nikołajczuk Małgorzata, Borowiak Ewa, Piatkowski Radoslaw, Grabowski Marcin, Budnik Monika
1st Department of Cardiology, Medical University of Warsaw, Stefana Banacha 1a, 02-097 Warsaw, Poland.
J Pers Med. 2025 Sep 4;15(9):425. doi: 10.3390/jpm15090425.
Takotsubo syndrome (TTS) is a condition marked by sudden and temporary dysfunction of the left ventricle, occurring without significant coronary artery disease. It was previously thought to be a benign and self-limiting condition, associated with a favorable long-term prognosis and minimal impact on survival. However, the most recent findings provide evidence that TTS is a heterogeneous condition with various presentation patterns. Using the most recent evidence regarding long-term prognosis in TTS, this review article aims to provide an overview of the long-term survival of patients with TTS, highlighting potential risk factors and comorbidities that may worsen prognosis. It also explores the risk of recurrence and the utility of advanced imaging modalities for prognosis assessment. Risk factors negatively impacting long-term outcomes include male sex, older age, reduced left ventricular ejection fraction (LVEF), physical triggers (especially pulmonary and neurological diseases), and comorbidities such as atrial fibrillation, chronic obstructive pulmonary disease, and active cancer. Recurrence, though relatively uncommon, can affect up to 11% of patients, with "super recurrence" linked to higher peak troponin levels, lower LVEF, and emotional triggers. Advanced imaging modalities-such as coronary angiography and ventriculography, which are considered the gold standard, along with serial echocardiographic assessment-combined with cardiac biomarkers, including relatively low peak troponin levels and markedly elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP), as well as diagnostic ratios like copeptin/NT-proBNP, provide a robust framework for differentiating TTS from acute coronary syndromes. Key findings suggest that chronic therapeutic strategies in the long-term management of TTS patients should focus on improving long-term outcomes and reducing the risk of mortality and TTS recurrence. Methods: A comprehensive review was conducted using PubMed (U.S. National Library of Medicine and National Institutes of Health) and Google Scholar to identify relevant English-language publications addressing the long-term prognosis, biomarkers, imaging, risk of recurrence, and long-term management of TTS.
应激性心肌病（TTS）是一种以左心室突然且暂时性功能障碍为特征的病症，其发生时并无明显的冠状动脉疾病。它曾被认为是一种良性的自限性疾病，具有良好的长期预后，对生存率的影响极小。然而，最新研究结果表明，TTS是一种具有多种表现形式的异质性疾病。本文利用关于TTS长期预后的最新证据，旨在概述TTS患者的长期生存情况，突出可能使预后恶化的潜在危险因素和合并症。本文还探讨了复发风险以及先进成像方式在预后评估中的作用。对长期预后产生负面影响的危险因素包括男性、高龄、左心室射血分数（LVEF）降低、身体诱因（尤其是肺部和神经系统疾病）以及合并症，如心房颤动、慢性阻塞性肺疾病和活动性癌症。复发虽然相对不常见，但可影响多达11%的患者，“超级复发”与更高的肌钙蛋白峰值水平、更低的LVEF以及情绪诱因有关。先进的成像方式，如被视为金标准的冠状动脉造影和心室造影，以及系列超声心动图评估，再结合心脏生物标志物，包括相对较低的肌钙蛋白峰值水平和显著升高的N末端B型利钠肽原（NT-proBNP），以及诸如 copeptin/NT-proBNP 等诊断比值，为区分TTS与急性冠状动脉综合征提供了一个强有力的框架。主要研究结果表明，TTS患者长期管理中的慢性治疗策略应侧重于改善长期预后，降低死亡率和TTS复发风险。方法：使用PubMed（美国国立医学图书馆和美国国立卫生研究院）和谷歌学术进行全面综述，以识别涉及TTS长期预后、生物标志物、成像、复发风险和长期管理的相关英文出版物。
