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Molecular Mechanisms of Takotsubo Syndrome

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Article Cardiac & Cardiovascular Systems

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 Omerovic et al.

Summary: The scientific statement on the pathophysiology of Takotsubo syndrome discusses various aspects including catecholamines, the sympathetic nervous system, vascular responses, the role of the nervous systems, gender differences, sex hormones, genetics, and chronic abnormalities of cardiovascular physiology in survivors. The limitations of current clinical and preclinical studies, implications for clinical management, and future research perspectives are also highlighted.

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Elmir Omerovic et al.

Summary: This scientific statement from the Heart Failure Association (HFA) of the European Society of Cardiology focuses on the pathophysiology of Takotsubo syndrome. It provides an overview of the disease and discusses the role of catecholamines and the sympathetic nervous system, as well as their direct effects on myocardial biology. The statement also explores the integrated effects on ventricular haemodynamics.

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Summary: This study investigates the specific metabolic adaptations in takotsubo patients and their implications for future therapies. The study reveals dysregulation of glucose and lipid metabolic pathways, impaired Ca2+ handling, inflammation, and upregulation of remodeling pathways in the hearts of takotsubo patients. However, the integrity of both mitochondria and cardiomyocytes is preserved.

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Summary: The circulating biomarkers miR-16 and miR-26a were found to be involved in the pathophysiology of Takotsubo syndrome (TTS), sensitizing the heart to TTS-like changes produced by adrenaline. These miRs are associated with anxiety and depression and may provide a mechanism whereby previous stress primes the heart, increasing the likelihood of TTS in the future.

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Summary: In a rat model of isoproterenol-induced Takotsubo syndrome, hyperthermia was found to be associated with the development of apical hypocontractility, suggesting a possible role of elevated body temperature in the pathogenesis of Takotsubo syndrome.

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Stress-associated neurobiological activity associates with the risk for and timing of subsequent Takotsubo syndrome

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Summary: The activity in the amygdala, a brain center linked to stress response, correlates with heightened risk of cardiovascular disease and Takotsubo syndrome (TTS). Research findings suggest that individuals with heightened amygdalar activity are more likely to develop TTS earlier than those with lower activity, indicating early neurobiological changes associated with stress-related diseases.

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Plasma catecholamine levels in the acute and subacute stages of takotsubo syndrome: Results from the Stockholm myocardial infarction with normal coronaries 2 study

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Stress-associated neurobiological activity associates with the risk for and timing of subsequent Takotsubo syndrome

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Summary: The activity in the amygdala is associated with stress perception and response, as well as the risk of cardiovascular disease. Individuals with higher amygdalar activity (AmygA) are more likely to develop Takotsubo syndrome (TTS), a heart failure syndrome triggered by acute stress. This heightened neurobiological activity is present years before the onset of TTS and may impact the timing of the syndrome, suggesting that stress-associated neural activity could be a potential therapeutic target for reducing stress-related diseases, including TTS.

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