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Gowdar et al. Vessel Plus 2017;1:129-36 Vessel Plus
DOI: 10.20517/2574-1209.2017.12
www.vpjournal.net
Review Open Access

Probable protective role of diabetes mellitus

in takotsubo cardiomyopathy: a review

Shreyas Gowdar , Samridhi Syal , Lovely Chhabra
2,3
1
2
1 Department of Medicine, Baystate Medical Center, Springfield, MA 01199, USA.
2 Department of Cardiovascular Diseases, Heartland Regional Medical Center, Marion, IL 62959, USA.
3 SIU School of Medicine, Southern Illinois University, Carbondale, IL 62901, USA.
Correspondence to: Dr. Lovely Chhabra, Department of Cardiovascular Diseases, Heartland Regional Medical Center, 3331 W. Deyoung Street, Marion,
IL 62959, USA. E-mail: lovids@hotmail.com
How to cite this article: Gowdar S, Syal S, Chhabra L. Probable protective role of diabetes mellitus in takotsubo cardiomyopathy: a review. Vessel
Plus 2017;1:129-36.

ABSTRACT
Article history: Takotsubo cardiomyopathy (TC) is a syndrome that predominantly affects postmenopausal
Received: 18 Apr 2017 women and is characterized by transient regional systolic dysfunction of the left ventricle
Accepted: 24 Jul 2017 which occurs in the absence of angiographic evidence of significant obstructive coronary artery
Published: 26 Sep 2017 disease. It is often but not always triggered by emotional or physical stressful stimuli. In most
cases, the regional ventricular dysfunction extends beyond a single epicardial coronary artery
Key words: territory. It typically involves the apex, with rare atypical presentations involving the base and
Diabetes mellitus, right ventricle. Although the pathophysiological underpinnings of TC have not been completely
stress cardiomyopathy, elucidated, possible mechanisms include catecholamine overactivity, diffuse multivessel
takotsubo cardiomyopathy coronary spasm, microvascular dysfunction and estrogen deficiency. The prevalence of diabetes
mellitus has been noted to be low in multiple studies of patients with TC. In this review, the
authors discuss the association between diabetes mellitus and TC, with a special emphasis on
the possible protective effect of diabetes mellitus in development of TC.

INTRODUCTION beyond a single epicardial coronary artery territory.
The first case was reported by Sato in Japan in 1990, [3]
Takotsubo cardiomyopathy (TC), also known as apical and since then, this syndrome has been increasingly
ballooning syndrome or broken heart syndrome, recognized around the globe. The typical and most
is a syndrome characterized by transient regional common presentation consists of apical dysfunction
systolic dysfunction of the left ventricle that occurs in leading to apical ballooning appearance on coronary
the absence of angiographic evidence of significant angiography, with basal hypercontractility. Atypical
obstructive coronary artery disease (CAD). [1,2] It is variants/presentations of TC are rare, and include
usually but not always triggered by emotional or transient dysfunction of basal, mid ventricular or right
physical stressful stimuli. It is predominantly seen in ventricular myocardium, with apical sparing. Although
postmenopausal women. The syndrome may acutely the pathophysiological underpinnings of TC have not
mimic as an acute coronary syndrome; however the been completely elucidated, possible mechanisms
regional left ventricular dysfunction extends often include catecholamine over-activity causing myocardial
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