Takotsubo syndrome: emerging concepts in diagnosis, prognosis and therapy

Takotsubo syndrome (TTS) is an acute reversible heart failure syndrome initially believed to represent a benign and self-limiting condition due to its usual rapid recovery of ejection fraction within days or weeks. However, the incidence of acute complications such as acute heart failure, left ventricular outflow tract obstruction and mitral regurgitation, are not infrequent and both in-hospital and long-term outcome can be not so favorable. Due to an increased awareness and recognition of the multiple clinical features of the syndrome, TTS is more and more diagnosed, although its real incidence is probably still underestimated. Even today, in the absence of prospective randomized studies, there are no guidelines on the treatment of TTS but only recommendations resulting from the experience of studies from individual centers and small observational registries. The aim of this review is to discuss the novelties in terms of diagnosis, prognostic stratification and management of TTS patients, highlighting potential challenges and unsolved issues.