Probable protective role of diabetes mellitus in takotsubo cardiomyopathy: a review

Takotsubo cardiomyopathy (TC) is a syndrome that predominantly affects postmenopausal women and is characterized by transient regional systolic dysfunction of the left ventricle which occurs in the absence of angiographic evidence of significant obstructive coronary artery 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 territory. It typically involves the apex, with rare atypical presentations involving the base and right ventricle. Although the pathophysiological underpinnings of TC have not been completely elucidated, possible mechanisms include catecholamine overactivity, diffuse multivessel 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