Metabolic Remodeling in Takotsubo Syndrome

Abstract

The heart requires a large and constant supply of energy that is mainly the result of an efficient metabolic machinery that converges on mitochondrial oxidative metabolism to maintain its continuous mechanical work. Perturbations in these metabolic processes may therefore affect energy generation and contractile function directly. Metabolism characteristics in takotsubo syndrome (TTS) reveal several metabolic alterations called metabolic remodeling , including the hyperactivity of sympathetic metabolism, derangements of substrate utilization, mitochondrial dysfunction and systemic metabolic disorders, ultimately contributing to the progression of the disease and the development of a persistent and long-term heart failure phenotype . In this review, we explore the current literature investigating the pathological metabolic alterations in TTS. Although the metabolic dysfunction in takotsubo hearts is initially recognized as a myocardial metabolic inflexibility, we suggest that widespread  alterations of systemic metabolism with complex interplay between the heart and peripheral tissues rather than just cardiometabolic disorders per se account for maladaptive functional and structural impairment under this condition.

Note:
Funding Information: This work has been supported by grants from the Top-notch Talents of "Six-one Projects" of Jiangsu Commission of Health (LGY2019036), Yangzhou social development project (YZ2018075 and YZ2020098) and Yangzhou Medical Talent (ZDRC201845).

Declaration of Interests: The authors report no relationships that could be construed as a conflict of interest.

Keywords: Takotsubo syndrome, Cardiac energetics, Metabolic remodeling, Cardiac metabolism, Systemic metabolism