Since its first description in Japan in 1990,1 takotsubo (stress) cardiomyopathy has gained worldwide recognition. However, after nearly 25 years of extensive efforts toward a better understanding of this disorder, current knowledge remains limited. The disease is characterized by transient systolic and diastolic left ventricular dysfunction with a variety of wall-motion abnormalities.2,3 It predominantly affects elderly women and is often preceded by an emotional or physical trigger,4 but the condition has also been reported with no evident trigger. In the acute phase, the clinical presentation, electrocardiographic findings, and biomarker profiles are often similar to those of an acute coronary syndrome. Although the cause of takotsubo cardiomyopathy remains unknown, the role of the brain–heart axis in the pathogenesis of the disease has been described.5,6
Takotsubo cardiomyopathy, which derives its name from the Japanese word takotsubo (“octopus pot”) to describe the characteristic ballooning of the left ventricular apex, is generally recognized as a benign disorder. However, patients are at risk for recurrence even years after the first event, and data on in-hospital and long-term outcomes are limited.7-10 The potential role of catecholamine excess in the pathogenesis of takotsubo cardiomyopathy has been long debated,11 and as such beta-blockers have been proposed as a therapeutic strategy.12 Nevertheless, to our knowledge, no prospective trials evaluating the therapeutic management have been reported to date. The aim of this study was to investigate the clinical features, define prognostic predictors, and assess the clinical course and outcome of takotsubo cardiomyopathy.