{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T16:44:51Z","timestamp":1782751491396,"version":"3.54.5"},"reference-count":88,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T00:00:00Z","timestamp":1782691200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"DSCTV","award":["BIRD202539"],"award-info":[{"award-number":["BIRD202539"]}]},{"name":"DSCTV","award":["U-Gov_BIRD2020_01"],"award-info":[{"award-number":["U-Gov_BIRD2020_01"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Takotsubo syndrome (TTS) is an acute disorder characterized by transient left ventricular dysfunction with typical regional wall motion abnormalities, most commonly apical ballooning. It accounts for 1\u20133% of all suspected acute coronary syndromes and up to 5\u20136% in women presenting with ST-segment elevation myocardial infarction requiring coronary angiography to exclude obstructive coronary artery disease. The pathophysiology of TTS is complex and not fully elucidated, with sympathetic hyperactivation playing a central role through calcium dysregulation, oxidative stress, and metabolic alterations. Both clinical and experimental data demonstrate the importance of inflammation, with cell infiltration and persistent immune activation exceeding the acute phase. Increasing evidence highlights the impact of coronary microvascular disfunction (CMVD) as a secondary phenomenon, with some findings that support its role as a causative substrate. Beyond well-known predisposing conditions such as female sex, postmenopausal age, and neurological and psychiatric disorders with the trigger of a physical or psychological event, numerous case reports associate the syndrome with chronic autoimmune diseases, even if clear experimental evidence remains poor and worthy of further study. Echocardiography and advanced imaging techniques, including cardiac magnetic resonance and positron emission tomography, have provided insights into transient CMVD, reversible myocardial edema, and metabolic impairment, strengthening our knowledge of the syndrome as a dynamic process. It is also of growing interest to perform invasive hemodynamic assessment to explain the increase in microvascular resistance. This review offers a comprehensive and up-to-date overview of these techniques in the context of TTS. Since clinically, TTS may be associated with significant morbidity and mortality, with some unexplained cases of long-term myocardial disfunction or even recurrence, a deeper understanding of the interplay between catecholamines, inflammation, immune substrate, and CMVD may improve risk stratification and lead to the development of targeted therapeutic strategies.<\/jats:p>","DOI":"10.3390\/life16071091","type":"journal-article","created":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T15:27:37Z","timestamp":1782746857000},"page":"1091","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Coronary Microvascular Dysfunction in Stress Cardiomyopathy: At the Heart of the Problem"],"prefix":"10.3390","volume":"16","author":[{"given":"Giorgio","family":"Piccolboni","sequence":"first","affiliation":[{"name":"Cardiology Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3076-4787","authenticated-orcid":false,"given":"Giovanni","family":"Civieri","sequence":"additional","affiliation":[{"name":"Cardiology Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy"},{"name":"PhD Program in Translation Specialistic Medicine \u201cG.B. Morgagni\u201d, Curriculum \u201cCardiovascular Sciences\u201d, University of Padua, 35128 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4828-7875","authenticated-orcid":false,"given":"Francesco","family":"Tona","sequence":"additional","affiliation":[{"name":"Cardiology Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2032","DOI":"10.1093\/eurheartj\/ehy076","article-title":"International Expert Consensus Document on Takotsubo Syndrome (Part I): Clinical Characteristics, Diagnostic Criteria, and Pathophysiology","volume":"39","author":"Ghadri","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1056\/NEJMoa1406761","article-title":"Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy","volume":"373","author":"Templin","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_3","first-page":"343","article-title":"Incidence and angiographic characteristics of patients with apical ballooning syndrome (takotsubo\/stress cardiomyopathy) in the HORIZONS-AMI trial: An analysis from a multicenter, international study of ST-elevation myocardial infarction","volume":"83","author":"Prasad","year":"2014","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1016\/j.ijcard.2015.03.162","article-title":"Mortality in takotsubo syndrome is similar to mortality in myocardial infarction\u2014A report from the SWEDEHEART registry","volume":"185","author":"Redfors","year":"2015","journal-title":"Int. J. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1955","DOI":"10.1016\/j.jacc.2018.07.072","article-title":"Stress Cardiomyopathy Diagnosis and Treatment: JACC State-of-the-Art Review","volume":"72","author":"Ma","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e160","DOI":"10.1111\/j.1528-1167.2011.03185.x","article-title":"Seizure-associated Takotsubo cardiomyopathy","volume":"52","author":"Wegner","year":"2011","journal-title":"Epilepsia"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2729","DOI":"10.1161\/STROKEAHA.116.014304","article-title":"Takotsubo-Like Myocardial Dysfunction in Ischemic Stroke: A Hospital-Based Registry and Systematic Literature Review","volume":"47","author":"Jung","year":"2016","journal-title":"Stroke"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"E6","DOI":"10.1002\/clc.22053","article-title":"The impact of stressor patterns on clinical features in patients with tako-tsubo cardiomyopathy: Experiences of two tertiary cardiovascular centers","volume":"35","author":"Song","year":"2012","journal-title":"Clin. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1320","DOI":"10.1016\/j.jacc.2009.02.020","article-title":"Stress cardiomyopathy after intravenous administration of catecholamines and beta-receptor agonists","volume":"53","author":"Abraham","year":"2009","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1253\/circj.72.106","article-title":"Local release of catecholamines from the hearts of patients with tako-tsubo-like left ventricular dysfunction","volume":"72","author":"Kume","year":"2008","journal-title":"Circ. J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1007\/s12350-008-9017-1","article-title":"Persisting myocardial sympathetic dysfunction in takotsubo cardiomyopathy","volume":"16","author":"Verberne","year":"2009","journal-title":"J. Nucl. Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1056\/NEJMoa043046","article-title":"Neurohumoral features of myocardial stunning due to sudden emotional stress","volume":"352","author":"Wittstein","year":"2005","journal-title":"N. Engl. J. Med."},{"key":"ref_13","unstructured":"Bonow, R.O., Mann, D.L., Tomaselli, G.F., Bhatt, D.L., Solomon, S.D., Libby, P., and Braunwald, E. (2021). Braunwald\u2019s Heart Disease\u2014A Textbook of Cardiovascular Medicine, Elsevier. [13th ed.]."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1152\/physrev.1999.79.2.609","article-title":"Molecular and cellular mechanisms of myocardial stunning","volume":"79","author":"Bolli","year":"1999","journal-title":"Physiol. Rev."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e17","DOI":"10.1016\/j.jacc.2009.10.035","article-title":"Global coronary artery spasm caused takotsubo cardiomyopathy","volume":"55","author":"Nojima","year":"2010","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1016\/j.ihj.2018.04.004","article-title":"Takotsubo syndrome and coronary vasospasm: Two faces of the same coin?","volume":"70","author":"Vilela","year":"2018","journal-title":"Indian Heart J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/j.amjcard.2004.04.030","article-title":"Clinical characteristics and thrombolysis in myocardial infarction frame counts in women with transient left ventricular apical ballooning syndrome","volume":"94","author":"Bybee","year":"2004","journal-title":"Am. J. Cardiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1253\/jcj.64.789","article-title":"Coronary microvascular abnormality in the reversible systolic dysfunction observed after noncardiac disease","volume":"64","author":"Sadamatsu","year":"2000","journal-title":"Jpn. Circ. J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.ijcard.2015.04.015","article-title":"Plausible speculations on the pathophysiology of Takotsubo syndrome","volume":"188","author":"Madias","year":"2015","journal-title":"Int. J. Cardiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"502","DOI":"10.4329\/wjr.v6.i7.502","article-title":"Usefulness of myocardial positron emission tomography\/nuclear imaging in Takotsubo cardiomyopathy","volume":"6","author":"Testa","year":"2014","journal-title":"World J. Radiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"163","DOI":"10.31083\/j.rcm2505163","article-title":"Impact of Coronary Microvascular Dysfunction in Takotsubo Syndrome: Cause, Consequence or Both?","volume":"25","author":"Caglioni","year":"2024","journal-title":"Rev. Cardiovasc. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1093\/ehjci\/jet079","article-title":"Contrast echocardiography reveals apparently normal coronary perfusion in a rat model of stress-induced (Takotsubo) cardiomyopathy","volume":"15","author":"Redfors","year":"2014","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_23","first-page":"184","article-title":"Coronary microvascular dysfunction in Takotsubo syndrome: Cause or consequence","volume":"11","year":"2021","journal-title":"Am. J. Cardiovasc. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1253\/circj.CJ-15-1283","article-title":"Reversible Microvascular Dysfunction in Takotsubo Syndrome Shown Using Index of Microcirculatory Resistance","volume":"80","author":"Warisawa","year":"2016","journal-title":"Circ. J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1093\/ejechocard\/jen222","article-title":"Transient impairment of coronary flow reserve in tako-tsubo cardiomyopathy is related to left ventricular systolic parameters","volume":"10","author":"Meimoun","year":"2009","journal-title":"Eur. J. Echocardiogr."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1319","DOI":"10.1093\/eurheartj\/ehq039","article-title":"Reversible coronary microvascular dysfunction: A common pathogenetic mechanism in Apical Ballooning or Tako-Tsubo Syndrome","volume":"31","author":"Galiuto","year":"2010","journal-title":"Eur. Heart J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1016\/j.ijcard.2016.09.008","article-title":"Endothelial function and sympathetic nervous system activity in patients with Takotsubo syndrome","volume":"224","author":"Naegele","year":"2016","journal-title":"Int. J. Cardiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1093\/cvr\/cvaa085","article-title":"Endothelial function in cardiovascular medicine: A consensus paper of the European Society of Cardiology Working Groups on Atherosclerosis and Vascular Biology, Aorta and Peripheral Vascular Diseases, Coronary Pathophysiology and Microcirculation, and Thrombosis","volume":"117","author":"Alexander","year":"2021","journal-title":"Cardiovasc. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"3216","DOI":"10.1002\/ehf2.14461","article-title":"Microvascular function and inflammatory activation in Takotsubo cardiomyopathy","volume":"10","author":"Solberg","year":"2023","journal-title":"ESC Heart Fail."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1016\/j.jacbts.2018.08.006","article-title":"Characterization of the Myocardial Inflammatory Response in Acute Stress-Induced (Takotsubo) Cardiomyopathy","volume":"3","author":"Wilson","year":"2018","journal-title":"JACC Basic Transl. Sci."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e156236","DOI":"10.1172\/jci.insight.156236","article-title":"Cardiac macrophages regulate isoproterenol-induced Takotsubo-like cardiomyopathy","volume":"7","author":"Liao","year":"2022","journal-title":"JCI Insight"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1161\/CIRCULATIONAHA.112.111591","article-title":"High levels of circulating epinephrine trigger apical cardiodepression in a \u03b22-adrenergic receptor\/Gi-dependent manner: A new model of Takotsubo cardiomyopathy","volume":"126","author":"Paur","year":"2012","journal-title":"Circulation"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1007\/s003800300005","article-title":"Histological study on the distribution of autonomic nerves in the human heart","volume":"18","author":"Kawano","year":"2003","journal-title":"Heart Vessel."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/S0022-2828(85)80130-9","article-title":"Catecholamine cardiotoxicity","volume":"17","author":"Rona","year":"1985","journal-title":"J. Mol. Cell. Cardiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.amjcard.2017.09.025","article-title":"Frequency of Inverted Electrocardiographic T Waves (Cerebral T Waves) in Patients with Acute Strokes and Their Relation to Left Ventricular Wall Motion Abnormalities","volume":"121","author":"Stone","year":"2018","journal-title":"Am. J. Cardiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1097\/00000542-197311000-00013","article-title":"Cardiac effects of stimulation and block of the stellate ganglion","volume":"39","author":"Rogers","year":"1973","journal-title":"Anesthesiology"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1016\/j.jelectrocard.2011.07.030","article-title":"A new electrocardiographic marker for sympathetic nerve stimulation: Modulation of repolarization by stimulation of stellate ganglia","volume":"44","author":"Ramirez","year":"2011","journal-title":"J. Electrocardiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2155","DOI":"10.1093\/eurheartj\/ehp240","article-title":"Abnormalities in intracellular Ca2+ regulation contribute to the pathomechanism of Tako-Tsubo cardiomyopathy","volume":"30","author":"Nef","year":"2009","journal-title":"Eur. Heart J."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"902","DOI":"10.1016\/j.jacc.2020.10.060","article-title":"Pathophysiology of Takotsubo Syndrome: JACC State-of-the-Art Review","volume":"77","author":"Lyon","year":"2021","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"854","DOI":"10.1016\/j.ejheart.2007.06.008","article-title":"Tako-Tsubo cardiomyopathy","volume":"9","author":"Brutsaert","year":"2007","journal-title":"Eur. J. Heart Fail."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1161\/01.RES.52.1.16","article-title":"Prejunctional and postjunctional actions of endogenous norepinephrine at the sympathetic neuroeffector junction in canine coronary arteries","volume":"52","author":"Cohen","year":"1983","journal-title":"Circ. Res."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"999","DOI":"10.1093\/eurheartj\/eht392","article-title":"A signature of circulating microRNAs differentiates takotsubo cardiomyopathy from acute myocardial infarction","volume":"35","author":"Jaguszewski","year":"2014","journal-title":"Eur. Heart J."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1161\/01.CIR.83.2.469","article-title":"Endothelin-1-induced vasoconstriction in humans. Reversal by calcium channel blockade but not by nitrovasodilators or endothelium-derived relaxing factor","volume":"83","author":"Kiowski","year":"1991","journal-title":"Circulation"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.ahj.2012.03.020","article-title":"Prevalence of Takotsubo cardiomyopathy in the United States","volume":"164","author":"Deshmukh","year":"2012","journal-title":"Am. Heart J."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1897","DOI":"10.1161\/STROKEAHA.111.646893","article-title":"The role of norepinephrine and estradiol in the pathogenesis of cardiac wall motion abnormality associated with subarachnoid hemorrhage","volume":"43","author":"Sugimoto","year":"2012","journal-title":"Stroke"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1253\/circj.71.565","article-title":"Chronic estrogen supplementation following ovariectomy improves the emotional stress-induced cardiovascular responses by indirect action on the nervous system and by direct action on the heart","volume":"71","author":"Ueyama","year":"2007","journal-title":"Circ. J."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1680","DOI":"10.1161\/01.STR.0000226461.52423.dd","article-title":"Adrenoceptor polymorphisms and the risk of cardiac injury and dysfunction after subarachnoid hemorrhage","volume":"37","author":"Zaroff","year":"2006","journal-title":"Stroke"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.1111\/all.12437","article-title":"Anaphylaxis: Guidelines from the European Academy of Allergy and Clinical Immunology","volume":"69","author":"Muraro","year":"2014","journal-title":"Allergy"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1016\/j.jacc.2009.10.031","article-title":"Pre-morbid psychiatric and cardiovascular diseases in apical ballooning syndrome (tako-tsubo\/stress-induced cardiomyopathy): Potential pre-disposing factors?","volume":"55","author":"Summers","year":"2010","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1097\/01.psy.0000173312.90148.97","article-title":"Depressive symptoms predict norepinephrine response to a psychological stressor task in Alzheimer\u2019s caregivers","volume":"67","author":"Mausbach","year":"2005","journal-title":"Psychosom. Med."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1097\/01.psy.0000195872.00987.db","article-title":"Psychophysiological mechanisms in panic disorder: A correlative analysis of noradrenaline spillover, neuronal noradrenaline reuptake, power spectral analysis of heart rate variability, and psychological variables","volume":"68","author":"Alvarenga","year":"2006","journal-title":"Psychosom. Med."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/j.hlc.2011.12.004","article-title":"Occurrence of Tako-Tsubo cardiomyopathy in association with ingestion of serotonin\/noradrenaline reuptake inhibitors","volume":"21","author":"Neil","year":"2012","journal-title":"Heart Lung Circ."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1001\/archneur.55.6.857","article-title":"Patients with epilepsy who die suddenly have cardiac disease","volume":"55","author":"Natelson","year":"1998","journal-title":"Arch. Neurol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"2598","DOI":"10.1093\/eurheartj\/ehm401","article-title":"A pathophysiologic study of tako-tsubo cardiomyopathy with F-18 fluorodeoxyglucose positron emission tomography","volume":"28","author":"Yoshida","year":"2007","journal-title":"Eur. Heart J."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1016\/j.jacc.2017.12.022","article-title":"Takotsubo Syndrome Associated with Structural Brain Alterations of the Limbic System","volume":"71","author":"Hiestand","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1898","DOI":"10.1093\/eurheartj\/ehab029","article-title":"Stress-associated neurobiological activity associates with the risk for and timing of subsequent Takotsubo syndrome","volume":"42","author":"Radfar","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1461","DOI":"10.1136\/heartjnl-2016-309783","article-title":"Takotsubo syndrome: Aetiology, presentation and treatment","volume":"103","author":"Kato","year":"2017","journal-title":"Heart"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1016\/j.ijcard.2012.09.050","article-title":"Diverse left ventricular morphology and predictors of short-term outcome in patients with stress-induced cardiomyopathy","volume":"168","author":"Kwon","year":"2013","journal-title":"Int. J. Cardiol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1084","DOI":"10.2337\/dc17-2609","article-title":"Prevalence and Prognostic Impact of Diabetes in Takotsubo Syndrome: Insights From the International, Multicenter GEIST Registry","volume":"41","author":"Stiermaier","year":"2018","journal-title":"Diabetes Care"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1615","DOI":"10.2169\/internalmedicine.55.6020","article-title":"Asthmatic Attack Complicated with Takotsubo Cardiomyopathy after Frequent Inhalation of Inhaled Corticosteroids\/Long-Acting Beta2-Adrenoceptor Agonists","volume":"55","author":"Saito","year":"2016","journal-title":"Intern. Med."},{"key":"ref_61","first-page":"7259200","article-title":"Takotsubo Cardiomyopathy and Autoimmune Disorders: A Systematic Scoping Review of Published Cases","volume":"2024","author":"Hosseini","year":"2024","journal-title":"Int. J. Clin. Pract."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1093\/rheumatology\/keaa504","article-title":"Takotsubo syndrome and rheumatic diseases-a critical systematic review","volume":"60","author":"Lin","year":"2021","journal-title":"Rheumatology"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1016\/j.jacbts.2018.11.003","article-title":"Takotsubo Syndrome: Latest Addition to the Expanding Family of Immune-Mediated Diseases?","volume":"3","author":"Sattler","year":"2018","journal-title":"JACC Basic Transl. Sci."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1561","DOI":"10.1172\/JCI44583","article-title":"Impaired thymic tolerance to \u03b1-myosin directs autoimmunity to the heart in mice and humans","volume":"121","author":"Lv","year":"2011","journal-title":"J. Clin. Investig."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.1038\/nm.3284","article-title":"B lymphocytes trigger monocyte mobilization and impair heart function after acute myocardial infarction","volume":"19","author":"Zouggari","year":"2013","journal-title":"Nat. Med."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"3037","DOI":"10.1084\/jem.20070885","article-title":"The healing myocardium sequentially mobilizes two monocyte subsets with divergent and complementary functions","volume":"204","author":"Nahrendorf","year":"2007","journal-title":"J. Exp. Med."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"872","DOI":"10.1093\/cvr\/cvab113","article-title":"Rituximab in patients with acute ST-elevation myocardial infarction: An experimental medicine safety study","volume":"118","author":"Zhao","year":"2022","journal-title":"Cardiovasc. Res."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"117179","DOI":"10.1016\/j.atherosclerosis.2023.06.970","article-title":"Association of autoantibodies targeting endothelin type-A receptors with no-reflow in ST-elevation myocardial infarction","volume":"378","author":"Tona","year":"2023","journal-title":"Atherosclerosis"},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Civieri, G., Iop, L., and Tona, F. (2022). Antibodies against Angiotensin II Type 1 and Endothelin 1 Type A Receptors in Cardiovascular Pathologies. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23020927"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1002\/ejhf.494","article-title":"Long-term excess mortality in takotsubo cardiomyopathy: Predictors, causes and clinical consequences","volume":"18","author":"Stiermaier","year":"2016","journal-title":"Eur. J. Heart Fail."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1016\/j.ijcard.2014.07.110","article-title":"Out-of-hospital versus in-hospital Takotsubo cardiomyopathy: Analysis of 3719 patients in the Diagnosis Procedure Combination database in Japan","volume":"176","author":"Isogai","year":"2014","journal-title":"Int. J. Cardiol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1253\/circj.69.934","article-title":"Assessment of coronary microcirculation in patients with takotsubo-like left ventricular dysfunction","volume":"69","author":"Kume","year":"2005","journal-title":"Circ. J."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1319","DOI":"10.1253\/circj.CJ-21-0848","article-title":"Pathophysiology of Coronary Microvascular Dysfunction","volume":"86","author":"Crea","year":"2022","journal-title":"Circ. J."},{"key":"ref_74","first-page":"397","article-title":"La patologia microvascolare coronarica: Meccanismi e contesti clinici [Coronary microvascular dysfunction: Mechanisms and clinical outcome]","volume":"23","author":"Indolfi","year":"2022","journal-title":"G. Ital. Cardiol."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"e29755","DOI":"10.1016\/j.heliyon.2024.e29755","article-title":"Systematic review of cardiovascular magnetic resonance imaging T1 and T2 mapping in patients with Takotsubo syndrome","volume":"10","author":"Humayra","year":"2024","journal-title":"Heliyon"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"5160","DOI":"10.1007\/s00330-018-5475-2","article-title":"Left ventricular myocardial deformation in Takotsubo syndrome: A cardiovascular magnetic resonance myocardial feature tracking study","volume":"28","author":"Stiermaier","year":"2018","journal-title":"Eur. Radiol."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"2395","DOI":"10.1002\/ehf2.14394","article-title":"Coronary microvascular dysfunction in Takotsubo syndrome and associations with left ventricular function","volume":"10","author":"Nickander","year":"2023","journal-title":"ESC Heart Fail."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1007\/s10554-022-02698-6","article-title":"Angiography-derived index of microvascular resistance in takotsubo syndrome","volume":"39","author":"Castaldi","year":"2023","journal-title":"Int. J. Cardiovasc. Imaging"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"939","DOI":"10.4244\/EIJV5I8A158","article-title":"Quantitative assessment of coronary microvascular function in patients with and without epicardial atherosclerosis","volume":"5","author":"Melikian","year":"2010","journal-title":"EuroIntervention"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"1801","DOI":"10.1007\/s10554-021-02254-8","article-title":"Angiography-derived index of microcirculatory resistance (IMRangio) as a novel pressure-wire-free tool to assess coronary microvascular dysfunction in acute coronary syndromes and stable coronary artery disease","volume":"37","author":"Scarsini","year":"2021","journal-title":"Int. J. Cardiovasc. Imaging"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1080\/07853890903022793","article-title":"Diffuse, marked, reversible impairment in coronary microcirculation in stress cardiomyopathy: A Doppler transthoracic echo study","volume":"41","author":"Rigo","year":"2009","journal-title":"Ann. Med."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"20200514","DOI":"10.1259\/bjr.20200514","article-title":"Advanced cardiac magnetic resonance imaging in takotsubo cardiomyopathy","volume":"93","author":"Ojha","year":"2020","journal-title":"Br. J. Radiol."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.hrthm.2012.09.004","article-title":"Apicobasal gradient of left ventricular myocardial edema underlies transient T-wave inversion and QT interval prolongation (Wellens\u2019 ECG pattern) in Tako-Tsubo cardiomyopathy","volume":"10","author":"Zorzi","year":"2013","journal-title":"Heart Rhythm."},{"key":"ref_84","doi-asserted-by":"crossref","unstructured":"Nayar, J., John, K., Philip, A., George, L., George, A., Lal, A., and Mishra, A. (2022). A Review of Nuclear Imaging in Takotsubo Cardiomyopathy. Life, 12.","DOI":"10.3390\/life12101476"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"e018266","DOI":"10.1161\/CIRCIMAGING.125.018266","article-title":"Global Microvascular Dysfunction and Incomplete Recovery in Takotsubo Syndrome: Insights from Serial PET Imaging","volume":"18","author":"Kadoya","year":"2025","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_86","doi-asserted-by":"crossref","unstructured":"Sans-Rosell\u00f3, J., Fern\u00e1ndez-Peregrina, E., Duran-Cambra, A., Carreras-Mora, J., Sionis, A., \u00c1lvarez-Garc\u00eda, J., and Garcia-Garcia, H.M. (2021). Coronary Microvascular Dysfunction in Takotsubo Syndrome Assessed by Angiography-Derived Index of Microcirculatory Resistance: A Pressure-Wire-Free Tool. J. Clin. Med., 10.","DOI":"10.3390\/jcm10194331"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1136\/heartjnl-2019-315909","article-title":"Coronary slow flow is associated with a worse clinical outcome in patients with Takotsubo syndrome","volume":"106","author":"Montone","year":"2020","journal-title":"Heart"},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"e133","DOI":"10.1111\/1755-5922.12047","article-title":"Safety and feasibility of levosimendan administration in takotsubo cardiomyopathy: A case series","volume":"31","author":"Santoro","year":"2013","journal-title":"Cardiovasc. Ther."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/7\/1091\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T15:55:46Z","timestamp":1782748546000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/7\/1091"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,29]]},"references-count":88,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["life16071091"],"URL":"https:\/\/doi.org\/10.3390\/life16071091","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,29]]}}}