Long-Term Prognosis, Risk Assessment, and Management of Patients Diagnosed with Takotsubo Syndrome: A Narrative Review.

Abstract

Takotsubo syndrome (TTS) is a condition marked by sudden and temporary dysfunction of the left ventricle, occurring without significant coronary artery disease. It was previously thought to be a benign and self-limiting condition, associated with a favorable long-term prognosis and minimal impact on survival. However, the most recent findings provide evidence that TTS is a heterogeneous condition with various presentation patterns. Using the most recent evidence regarding long-term prognosis in TTS, this review article aims to provide an overview of the long-term survival of patients with TTS, highlighting potential risk factors and comorbidities that may worsen prognosis. It also explores the risk of recurrence and the utility of advanced imaging modalities for prognosis assessment. Risk factors negatively impacting long-term outcomes include male sex, older age, reduced left ventricular ejection fraction (LVEF), physical triggers (especially pulmonary and neurological diseases), and comorbidities such as atrial fibrillation, chronic obstructive pulmonary disease, and active cancer. Recurrence, though relatively uncommon, can affect up to 11% of patients, with "super recurrence" linked to higher peak troponin levels, lower LVEF, and emotional triggers. Advanced imaging modalities-such as coronary angiography and ventriculography, which are considered the gold standard, along with serial echocardiographic assessment-combined with cardiac biomarkers, including relatively low peak troponin levels and markedly elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP), as well as diagnostic ratios like copeptin/NT-proBNP, provide a robust framework for differentiating TTS from acute coronary syndromes. Key findings suggest that chronic therapeutic strategies in the long-term management of TTS patients should focus on improving long-term outcomes and reducing the risk of mortality and TTS recurrence. Methods: A comprehensive review was conducted using PubMed (U.S. National Library of Medicine and National Institutes of Health) and Google Scholar to identify relevant English-language publications addressing the long-term prognosis, biomarkers, imaging, risk of recurrence, and long-term management of TTS.