Characterization of the Myocardial Inflammatory Response in Acute Stress-Induced (Takotsubo) Cardiomyopathy.

•Takotsubo cardiomyopathy is an acute heart failure syndrome often triggered by emotional or physical stress, where no treatment currently exists, and exact pathogenic mechanisms are unclear.•Rats in which takotsubo-like cardiomyopathy was induced showed localized myocardial inflammatory changes, including progressive inflammatory infiltrates and myofiber atrophy, that persisted over the 14-day time course examined.•Early neutrophil infiltrates were followed by clusters of myocardial macrophages, typically of an M1 proinflammatory phenotype, with no switch to M2 resolving macrophages; individual M2 macrophage levels, however, correlated with recovery in cardiac function. Human post-mortem myocardial tissue shared features of the experimental model demonstrating M1 macrophage clusters.•The persistent clinical symptoms and long-term morbidity/mortality observed in takotsubo patients may, in part, relate to chronic nonresolving myocardial inflammation.