Identification of Takotsubo syndrome in intensive care units: A scoping review

The objective of this scoping review was to evaluate existing evidence on assessment and screening tools for Takotsubo syndrome (TTS) with a focus on understanding whether a clinical pathway tailored for intensive care unit (ICU) patients is warranted, given the high risk and complex presentation of Takotsubo syndrome in critically ill populations.

This review followed the framework of Arksey and O'Malley. Searches spanned 10 databases, including MEDLINE, EMBASE, and CINAHL, plus grey literature, covering English-language studies on adults. The search strategy included Medical Subject Headings terms, keywords, Boolean operators, and truncations. We organised citations with EndNote (Clarivate Analytics, Philadelphia, PA, USA) and screened studies using Covidence, with eligibility confirmed by consensus.

Thirty-two studies met the inclusion criteria, with publications ranging from 1990 to June 2024. Fourteen studies assessed electrocardiographic features to distinguish TTS from other cardiac conditions; 11 studies examined biomarkers with the potential for early detection of TTS. Five studies assessed echocardiographic markers for identifying transient left ventricular dysfunction associated with TTS. Two scoring systems, the International Takotsubo score and Platelets and Thrombosis in Sheba score, show potential for TTS diagnosis but lack validation specific to the ICU, limiting clinical utility. This review found that integrating distinctive electrocardiographic patterns and elevated biomarker ratios could provide valuable early indicators of TTS in intensive care settings. Echocardiographic parameters, including contrast imaging and wall motion score indices, could further support differentiation of TTS from other acute myocardial conditions in critically ill patients.

This review highlights gaps in ICU-specific TTS assessment practices, suggesting that developing a tailored clinical pathway, followed by validation, could support early recognition and management of TTS in ICU settings, enabling timely intervention and enhancing patient outcomes.