Risk stratification in takotsubo syndrome and its atypical association with diabetes mellitus: A review of current evidence

Takotsubo syndrome (TTS), also known as broken heart syndrome, is an acute cardiac condition with a poorly understood pathophysiology due to its relative rarity. Once considered benign, it is now recognized as a serious disorder with severe complications and a mortality rate comparable to or exceeding that of acute coronary syndrome. This narrative review aims to summarize current knowledge on the prognostic factors associated with TTS, with a particular focus on its relationship with diabetes mellitus (DM). A thorough analysis of 57 relevant studies, selected from over 98,000 articles retrieved from PubMed and Google Scholar, was conducted based on strict inclusion criteria. The findings indicate that advanced age, female sex, pre-existing cardiovascular diseases, and systemic disorders significantly influence the prognosis and mortality of patients with the syndrome. DM plays a paradoxical role, being associated with increased long-term mortality risk while potentially providing a protective effect during the acute phase of the syndrome, possibly by modulating stress responses involved in its onset. Therefore, a deeper understanding of the prognostic implications of TTS and its interaction with diabetes is crucial for developing appropriate risk stratification tools and improving clinical management of patients.