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Microvascular dysfunction in Takotsubo syndrome: a systematic review.

Luca Arcari1,2, Lucrezia Netti2, Giovanni Camastra1

  • 1Cardiology Unit, Madre Giuseppina Vannini Hospital, Rome, Italy.

Postgraduate Medicine
|January 19, 2026
PubMed
Summary

Microvascular dysfunction (MD) in Takotsubo syndrome (TTS) varies significantly, and is not always present. MD in TTS is a potential prognostic marker, but its role as a therapeutic target requires further investigation.

Keywords:
Takotsubo syndromecardiac magnetic resonance imagingindex of microvascular resistancemicrovascular dysfunctionmyocardial edema

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Area of Science:

  • Cardiology
  • Cardiovascular Research
  • Internal Medicine

Background:

  • Microvascular dysfunction (MD) is a proposed key mechanism in Takotsubo syndrome (TTS).
  • Existing research on MD in TTS lacks a comprehensive systematic review.
  • This review synthesizes current evidence on MD in TTS.

Purpose of the Study:

  • To systematically review and analyze studies investigating microvascular dysfunction in Takotsubo syndrome.
  • To assess the prevalence, diagnostic methods, and clinical implications of MD in TTS.

Main Methods:

  • A systematic search of major databases (Embase, Medline, Scopus, PubMed) was conducted.
  • Studies published in English, focusing on microvascular function in human TTS patients, were included.
  • Exclusion criteria included case reports, non-human studies, and investigations of non-cardiac microvasculature.

Main Results:

  • 35 studies met the inclusion criteria, employing diverse techniques like angiography, invasive measurements (IMR), echocardiography, nuclear medicine, and CMR.
  • Prevalence of MD in TTS varied widely (35%-100%) based on diagnostic criteria.
  • MD was associated with increased systolic impairment and, in limited studies, higher rates of major adverse cardiovascular events and mortality.

Conclusions:

  • MD prevalence in TTS is variable, and its absence in some cases questions its necessity for disease onset.
  • The presence and extent of MD in TTS show promise as a prognostic indicator.
  • Current evidence does not support MD in TTS as a confirmed therapeutic target in humans.