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Life
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Current and Future Perspectives of Takotsubo Syndrome
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Current and Future Perspectives of Takotsubo Syndrome

A special issue of Life (ISSN 2075-1729). This special issue belongs to the section "Physiology and Pathology".

Deadline for manuscript submissions: 31 May 2026 | Viewed by 593

Special Issue Editor

Dr. Luca Arcari

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Guest Editor
Cardiology Unit, Madre Giuseppina Vannini Hospital, Rome, Italy
Interests: takotsubo syndrome; cardiomyopathy; cardiac magnetic resonance; cardiovascular imaging
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Takotsubo Syndrome (TTS) is an increasingly recognized acute heart failure condition, mimicking myocardial infarction in its clinical presentation but without any culprit coronary artery disease. Once considered benign and self-limiting, TTS is now understood to carry a significant risk of complications, recurrence and long-term adverse events, warranting deeper exploration into its mechanisms and management. This Special Issue invites high-quality original research, comprehensive reviews, and expert perspectives that investigate current knowledge and future directions in the field. We welcome submissions addressing, but not limited to, the following themes:

  • Pathophysiology: New insights into the complex mechanisms of TTS, particularly the interplay between inflammation, coronary microvascular dysfunction, and the brain–heart axis. Special interest will be given to studies exploring the role of neurohumoral dysregulation, emotional or physical stress triggers, and central autonomic network involvement in precipitating myocardial dysfunction.
  • Advanced Cardiac Imaging: The use of echocardiography, cardiac magnetic resonance (CMR), computed tomography, and nuclear imaging for differential diagnosis, characterization of atypical variants, and risk stratification.
  • Therapeutic Approaches: Evolving strategies in the acute and long-term management of TTS, including cardioprotective therapies, autonomic modulation, and interventions targeting underlying inflammatory or neurovascular pathways.
  • Epidemiology: Population-based studies and registries that provide updated data on the incidence, prevalence, demographic distribution, seasonal variation, and recurrence rates of TTS are encouraged. Manuscripts exploring disparities in diagnosis and outcomes across sex, age, and geographical regions are particularly welcome, as such insights are vital for tailoring public health strategies and clinical interventions.

This Special Issue aims to foster a multidisciplinary understanding of TTS and its clinical implications.

Dr. Luca Arcari
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Life is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • takotsubo syndrome
  • heart failure
  • microvascular dysfunction
  • inflammation
  • myocardial edema
  • heart–brain axis
  • echocardiography
  • cardiac magnetic resonance
  • computed tomography
  • nuclear imaging

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Published Papers (2 papers)

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Research

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13 pages, 721 KB  
Article
Hepatic T1 Mapping in Takotsubo Syndrome: A Preliminary Imaging Insight into the Cardiohepatic Axis
by Riccardo Cau, Alessandro Pinna, Maria Francesca Marchetti, Jasjit S. Suri, Roberta Montisci and Luca Saba
Life 2025, 15(9), 1335; https://doi.org/10.3390/life15091335 - 22 Aug 2025
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Abstract
Background: Takotsubo syndrome (TS) is an acute heart failure characterized by transient systolic dysfunction of the left ventricle (LV). Given the complex cardiohepatic interactions in heart failure, the purpose of this study was to examine the role of hepatic T1 mapping in TS [...] Read more.
Background: Takotsubo syndrome (TS) is an acute heart failure characterized by transient systolic dysfunction of the left ventricle (LV). Given the complex cardiohepatic interactions in heart failure, the purpose of this study was to examine the role of hepatic T1 mapping in TS patients as an imaging biomarker of the cardiohepatic axis and to explore its correlation with demographics, laboratory data, and cardiovascular magnetic resonance (CMR) findings. Methods: In this retrospective pilot study, CMR was performed in 62 consecutive patients with TS (54 females, 73.47 ± 9.88 years). Additionally, 24 age- and sex-matched control subjects were included (20 females, 69.67 ± 6.88 years). A dedicated CMR software (CV42 6.0, CVI42, Circle Cardiovascular Imaging Inc., Calgary, AB, Canada) was used to assess atrial and ventricular strain parameters, as well as parametric mapping, including hepatic T1 mapping. Results: TS patients exhibited significantly higher hepatic T1 mapping values compared with the age-, sex-, and cardiovascular risk factor-matched control group (499.80 ± 141.86 vs. 425.26 ± 51.91, p = 0.017). In multivariable analysis, hepatic T1 mapping was independently associated with right ventricular (RV) longitudinal strain (β coefficient = 2.936, p = 0.007) and N-terminal pro-B-type natriuretic peptide (β coefficient = 2.395, p = 0.024). Conclusions: In this pilot study, hepatic T1 mapping was elevated in TS patients, suggesting its potential role as an imaging biomarker of cardiohepatic interaction. Hepatic T1 also showed independent associations with RV longitudinal strain and N-terminal pro-B-type natriuretic peptide, both well-known markers of adverse outcomes in TS. These preliminary findings warrant validation in larger studies. Full article
(This article belongs to the Special Issue Current and Future Perspectives of Takotsubo Syndrome)
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Review

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17 pages, 863 KB  
Review
When a Woman’s Heart Fails to Contain: Takotsubo Syndrome as a Gendered Collapse of Emotional Regulation
by Giuseppe Marano, Enrico Romagnoli, Giuseppe Biondi-Zoccai, Gianandrea Traversi, Osvaldo Mazza, Roberto Pola, Eleonora Gaetani and Marianna Mazza
Life 2025, 15(9), 1431; https://doi.org/10.3390/life15091431 - 12 Sep 2025
Abstract
Background: 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, [...] Read more.
Background: 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. Methods: 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. Results: 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. Conclusions: 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. Full article
(This article belongs to the Special Issue Current and Future Perspectives of Takotsubo Syndrome)
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