Lang SY, Xia F. Takotsubo syndrome: A review of psychobiological mechanisms and clinical practice interventions. World J Psychiatry 2026; 16(9): 120218 [DOI: 10.5498/wjp.120218]
Corresponding Author of This Article
Fei Xia, PhD, Associate Professor, Department of Cardiology, People’s Hospital of China Medical University (Liaoning Provincial People’s Hospital), No. 3 Wenyi Road, Shenhe District, Shenyang 110016, Liaoning Province, China. xf19870421@126.com
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Psychiatry
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review-article
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Lang SY, Xia F. Takotsubo syndrome: A review of psychobiological mechanisms and clinical practice interventions. World J Psychiatry 2026; 16(9): 120218 [DOI: 10.5498/wjp.120218]
World J Psychiatry. Sep 19, 2026; 16(9): 120218 Published online Sep 19, 2026. doi: 10.5498/wjp.120218
Takotsubo syndrome: A review of psychobiological mechanisms and clinical practice interventions
Shu-Yi Lang, Fei Xia
Shu-Yi Lang, Department of Cardiovascular Medicine, The First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
Fei Xia, Department of Cardiology, People’s Hospital of China Medical University (Liaoning Provincial People’s Hospital), Shenyang 110016, Liaoning Province, China
Author contributions: Lang SY contributed to the writing and editing of the manuscript; Lang SY and Xia F contributed to the literature search, designed the overall concept and outline of the manuscript; and all authors have read and approve the final manuscript.
AI contribution statement: DeepL was used for language polishing and translation.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Fei Xia, PhD, Associate Professor, Department of Cardiology, People’s Hospital of China Medical University (Liaoning Provincial People’s Hospital), No. 3 Wenyi Road, Shenhe District, Shenyang 110016, Liaoning Province, China. xf19870421@126.com
Received: March 13, 2026 Revised: April 13, 2026 Accepted: June 9, 2026 Published online: September 19, 2026 Processing time: 163 Days and 21.7 Hours
Abstract
Takotsubo syndrome (TTS), an acute and reversible form of cardiomyopathy caused by psychological or physiological stress, continues to present unresolved questions regarding its pathogenesis, diagnostic frameworks, and interventional strategies. This review systematically summarizes the epidemiological characteristics, psychobiological mechanisms, diagnostic approaches, psychological intervention strategies, research trajectories, current landscape, future directions, and ongoing controversies and challenges associated with TTS. Epidemiological evidence indicates that TTS occurs predominantly in postmenopausal women and is influenced by psychological factors, such as anxiety and post-traumatic stress disorder, as well as physiological stressors, such as infection and surgery, which collectively contribute to its pathogenesis. The central pathophysiological mechanisms include sympathetic nervous system hyperactivation, catecholamine-mediated myocardial toxicity, and coronary microvascular dysfunction. From a diagnostic perspective, the integration of multimodal imaging techniques, including echocardiography and cardiac magnetic resonance imaging, with structured psychological assessment tools has enhanced the diagnostic precision. Psychological interventions, including cognitive-behavioral therapy and group-based psychological support, are receiving increasing attention for their potential role in improving clinical outcomes. Current research focuses on clarifying the multidimensional mechanisms underlying TTS and advancing personalized treatment approaches. However, important challenges persist, including ongoing etiological debates, limited high-quality evidence regarding the effectiveness of psychological interventions, and unresolved ethical and methodological concerns. Future investigations should prioritize the elucidation of the molecular substrates of psychobiological mechanisms, evaluation of emerging psychological intervention modalities, and development of precision-based therapeutic strategies to support the standardized and individualized clinical management of TTS.
Core Tip: Takotsubo cardiomyopathy is a stress-induced cardiac condition with significant psychobiological underpinnings. This review synthesizes evidence on the role of psychological factors, including anxiety and post-traumatic stress disorder, in Takotsubo cardiomyopathy pathogenesis and prognosis. It highlights diagnostic approaches integrating imaging and psychological assessments, and evaluates psychological interventions such as cognitive behavioral therapy and group support, which may improve outcomes. Ongoing controversies and future directions for personalized treatment are discussed, emphasizing the need for multidisciplinary management of this mind-heart disorder.
