Marano Giuseppe, Romagnoli Enrico, Biondi-Zoccai Giuseppe, Traversi Gianandrea, Mazza Osvaldo, Pola Roberto, Gaetani Eleonora, Mazza Marianna
Unit of Psychiatry, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy.
Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
Life (Basel). 2025 Sep 12;15(9):1431. doi: 10.3390/life15091431.
Takotsubo Syndrome (TTS), or stress-induced cardiomyopathy, is an acute and typically reversible cardiac condition that mimics acute coronary syndrome without obstructive coronary artery disease. Predominantly affecting postmenopausal women, TTS has been increasingly recognized as a psychobiological disorder involving neuroendocrine dysregulation, autonomic imbalance, psychosocial stress, and gendered patterns of emotional regulation. This review aimed to synthesize multidisciplinary evidence to propose an integrative, gender-informed model of TTS.
A narrative literature review was conducted using PubMed/MEDLINE, Scopus, and Web of Science (2000-2025) to identify clinical, neurobiological, psychosocial, and psychoanalytic studies addressing sex/gender differences, psychiatric comorbidities, and emotional regulation in TTS.
Evidence indicates that catecholamine surge, hypothalamic-pituitary-adrenal axis dysregulation, estrogen deficiency, and autonomic imbalance provide a biological substrate for stress-induced myocardial stunning. Psychosocial factors, such as caregiving burden, chronic stress, and alexithymia, further decrease resilience. Gendered coping scripts and unconscious symbolic processes may amplify vulnerability and influence clinical presentation. The integrative model combines biological, psychological, and social mechanisms, highlighting the predominance of emotional triggers in women and worse in-hospital outcomes in men.
TTS should be approached as both a cardiac and affective disorder. Gender-sensitive, multidisciplinary management, including psychiatric screening, psychocardiology interventions, and psychoanalytically informed care, may improve prevention, diagnosis, and patient outcomes.
Takotsubo综合征（TTS），即应激性心肌病，是一种急性且通常可逆的心脏疾病，可模拟无阻塞性冠状动脉疾病的急性冠状动脉综合征。TTS主要影响绝经后女性，越来越被认为是一种涉及神经内分泌失调、自主神经失衡、心理社会压力和性别化情绪调节模式的心理生物学障碍。本综述旨在综合多学科证据，提出一个综合的、考虑性别的TTS模型。
使用PubMed/MEDLINE、Scopus和Web of Science（2000 - 2025年）进行叙述性文献综述，以识别涉及TTS中性别差异、精神共病和情绪调节的临床、神经生物学、心理社会和精神分析研究。
证据表明，儿茶酚胺激增、下丘脑 - 垂体 - 肾上腺轴失调、雌激素缺乏和自主神经失衡为应激性心肌顿抑提供了生物学基础。心理社会因素，如照顾负担、慢性压力和述情障碍，会进一步降低恢复力。性别化的应对方式和无意识的象征过程可能会增加易感性并影响临床表现。综合模型结合了生物学、心理学和社会机制，强调情绪触发因素在女性中占主导地位，而男性的住院结局更差。
TTS应被视为一种心脏和情感障碍。对性别敏感的多学科管理，包括精神科筛查、心理心脏病学干预和基于精神分析的护理，可能会改善预防、诊断和患者结局。
