Pathophysiology of Takotsubo syndrome – a joint scientific statement from the Heart Failure Association Takotsubo Syndrome Study Group and Myocardial Function Working Group of the European Society of Cardiology – Part 2: vascular pathophysiology, gender and sex hormones, genetics, chronic cardiovascular problems and clinical implications
Elmir Ömerovic, Rodolfo Citro, Eduardo Bossone, Björn Redfors, Johannes Backs, Bastian Bruns, Michele Ciccarelli, Liam S. Couch, Dana Dawson, Guıdo Grassı, Massimo Iacoviello, Guido Parodi, Birke Schneider, Christian Templin, Jelena R. Ghadri, Thomas Thum, Ovidiu Chioncel, Carlo G. Tocchetti, Jolanda van der Velden, Stéphane Heymans, Alexander R. Lyon
Abstract
While the first part of the scientific statement on the pathophysiology of Takotsubo syndrome was focused on catecholamines and the sympathetic nervous system, in the second part we focus on the vascular pathophysiology including coronary and systemic vascular responses, the role of the central and peripheral nervous systems during the acute phase and abnormalities in the subacute phase, the gender differences and integrated effects of sex hormones, genetics of Takotsubo syndrome including insights from microRNA studies and inducible pluripotent stem cell models of Takotsubo syndrome. We then discuss the chronic abnormalities of cardiovascular physiology in survivors, the limitations of current clinical and preclinical studies, the implications of the knowledge of pathophysiology for clinical management and future perspectives and directions of research.