The present review focuses on the particulars of the hemodynamic assessment of patients with Takotsubo syndrome (TTS), i.e., blood pressure, cardiac output, systemic vascular resistance, left ventricular ejection fraction, left ventricular-arterial coupling (VAC), left ventricular end-diastolic pressure (LVEDP), and their importance in the management of patients with TTS, and the unraveling of its pathophysiology. In addition, the review discusses the discrepancies noted in the reported literature on the LVEDP and the left VAC, speculating as to the underlying reasons, and providing recommendations.

BACKGROUND:Increasing recognition of takotsubo syndrome (TTS) is being realized since its formal description in 1990/1991 with information provided in case reports, patient series, and multinational registries. The present study aimed at gathering all the patient reports published in the world literature in 2024 to evaluate possible changes in the diagnosis and management of TTS, as compared with TTS registries. METHODS:All the patients with TTS and granular data published in PubMed in response to the MeSH term "takotsubo" in 2024 were scrutinized with data tabulated pertaining to 85+ variables, and compared with the corresponding data deriving from the latest published reports of the InterTak, RETAKO, and GEIST TTS registries. RESULTS:The present study comprised 246 patients aged 58.2 ± 20.3, with 41 (16.7%) being male, reported from 51 countries, and were characterized by comparison with the 8,288 patients from the 3 registries, by lower rates of risk factors for CAD and cancer, very high comorbidity burden (86.2%), "physical stress"-triggered TTS (69.5% vs. 47.5%, 28.%, 35.5%, for the 3 registries, correspondingly, P = 0.00001), and higher rates of cardiogenic shock (20.7% vs 8.5%, 10.5%, and 8.1%, P = 0.00001), in-hospital mortality (6.9% vs 5.5%, 2.3%, P = 0.00001), and recurrence of TTS (7.3% vs 3.2%, P = 0.02). CONCLUSIONS:The patients with TTS published in the world literature in 2024 comprise a younger group revealing lower risks for CAD and cancer, and higher rates of comorbidity, "physical stress"-triggered TTS, in-hospital complications, mortality, and TTS recurrence, as compared to patients published heretofore.

ABSTRACT Some patients with takotsubo syndrome reveal transiently features of hypertrophic cardiomyopathy at imaging, particularly of the apical variety; this “pseudohypertrophy” is due to myocardial edema, and can be diagnosed by the absence of electrocardiogram evidence of left ventricular hypertrophy, and particularly a transient reduction of the amplitude of QRS complexes.

A comparison of data on patients with takotsubo syndrome (TTS), from the World literature (WL) 2024 with the InterTalk 2016-2018 registry subgroup showed a much younger population of patients suffering TTS triggered by physical stresses, with a high rate of neurological and other comorbidities in the former. While the rates of hypertension and hypercholesterolemia, and prescription of β-blockers, ACE-inhibitors/Angiotensin blockers, and aspirin at discharge were higher in InterTAK, resuscitation, cardiogenic shock, mechanical support, and thrombus formation was higher in WL.

This short communication aims at raising an insight about an observation made 26 years ago, describing a transient false positive electrocardiogram (ECG)-based diagnosis of left ventricular hypertrophy (LVH) in patients with various tachycardias (e.g, sinus, supraventricular, atrial fibrillation) with or without evidence of LVH as assessed by cardiac imaging. The mechanism is purported to be due to a tachycardia-mediated shortening of the diastolic left ventricular (LV) dimensions due to tachycardias, with the diastolic LV volume centroid displaced closer to the anterior chest wall (e.g. "Wilson's proximity effect"). This insight prevents an inappropriate diagnosis of LVH; also, it is possible that the absence of such a phenomenon during tachycardias may imply in some cases advanced acute or chronic heart failure, resulting in LV diastolic dilatation, counteracting this ECG phenomenon. The author advocates that automated ECG interpretation algorithms providing interpretation upon recording of an ECG should be modified to reflect on this insight, since many physicians rely inappropriately on the automated ECG interpretation.

Takotsubo syndrome (TTS), popularly known as “broken heart syndrome”, is a type of reversible but not benign acute heart failure condition of unknown etiology, usually triggered by physical or emotional stress, affecting primarily elderly women. Recently a subtype of TTS, triggered by positive/pleasant emotions, has been identified (“happy heart syndrome”) with affected patients showing the same complications, including in-hospital and long-term mortality, as the patients afflicted with the “broken heart syndrome”. There is a need to increase the awareness of physicians, other medical providers, our patients, and the general public about the existence of “happy heart syndrome”.

It is increasingly apparent that takotsubo syndrome (TTS) and spontaneous coronary artery dissection (SCAD) are associated. While the pathophysiology of TTS and SCAD are still debated, there should not be much doubt that SCAD could trigger TTS, as the latter often emerges in the context of a great variety of physical and emotional stresses, and thus SCAD should not be excluded as a TTS precipitant. In regards to TTS precipitating SCAD, it has been proposed that the anatomic junction of vigorously contracting base of the heart and the abutting akinetic/dyskinetic mid-ventricular/apical myocardium, could form a "hinge pivoting point", exerting a disrupting mechanical influence on the coronary vessels crossing these 2 planes, precipitating tearing of the coronary vessel wall, formation of an intramural hematoma, with resultant SCAD in susceptible individuals. This review also provides a detailed list of recommendations for exploring the plausible association of TTS and SCAD, irrespective of their temporal sequence of occurrence.