Left ventricular function recovery in Takotsubo syndrome, clinical and pathophysiological insights: a state-of-the-art review.

Purpose of review: Early (<10 days) recovery of the left ventricular ejection fraction (LVEF) in Takotsubo syndrome (TTS) has been associated with better short- and long-term clinical outcomes compared to delayed recovery (>10 days). This review aims to comprehensively address the literature regarding its clinical implications, the pathological basis underlying a chronic inflammatory heart failure phenotype; as well as the potential pharmacological and nonpharmacological therapies that might aid in LVEF recovery and improve clinical outcomes in TTS.

Recent findings: We describe the clinical findings of the two large studies addressing this topic, derived from ongoing prospective registries (RETAKO and InterTAK) in which inflammatory biomarkers are the strongest independently associated factor with late left ventricular (LV) recovery (>10 days). This is in line with the previous studies suggesting a chronic inflammatory phenotype with elevated inflammatory biomarkers (e.g. interleukin-6) that persists even 5 months after the index event and long-lasting myocardial energetic impairment >1 year after the TTS episode.

Summary: Late LV recovery in TTS is linked to a worse short- and long-term prognosis, identifying these patients for closer monitoring might be clinically relevant for the early detection of complications. Mechanistical research needs to be undertaken to elucidate the cellular and molecular pathways implicated in late LV recovery, this could aid in the selection of pharmacological and nonpharmacological therapies to aid LV recovery.