Pathophysiology of <scp>T</scp> akotsubo syndrome – a joint scientific statement from the Heart Failure Association <scp>T</scp> akotsubo Syndrome Study Group and Myocardial Function Working Group of the <scp>E</scp> uropean Society of Cardiology – Part 1: overview and the central role for catecholamines and sympathetic nervous system
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
This is the first part of a scientific statement from the Heart Failure Association (HFA) of the European Society of Cardiology focused upon the pathophysiology of Takotsubo syndrome and is complimentary to the previous HFA position statement on Takotsubo syndrome which focused upon clinical management. In part 1 we provide an overview of the pathophysiology of Takotsubo syndrome and fundamental questions to consider. We then review and discuss the central role of catecholamines and the sympathetic nervous system in the pathophysiology, and the direct effects of high surges in catecholamines upon myocardial biology including β-adrenergic receptor signalling, G-protein coupled receptor kinases, cardiomyocyte calcium physiology, myofilament physiology, cardiomyocyte gene expression, myocardial electrophysiology and arrhythmogenicity, myocardial inflammation, metabolism and energetics. The integrated effects upon ventricular haemodynamics are discussed and integrated into the pathophysiological model.