Anxiety trait in patients with stress-induced cardiomyopathy: a case–control study

Abstract

Background Stress-induced Tako-tsubo cardiomyopathy (TTC) is an acute cardiac syndrome, mimics ST elevation myocardial infarction (STEMI), largely confined to postmenopausal women, frequently precipitated by a stressful event. The pathogenesis of TTC is still unknown. Some authors hypothesized a possible connection between TTC and anxiety disease, but no previous study analyzed the relationship between anxiety trait and TTC. This study sought to assess the potential role of anxiety trait in the development and clinical course of TTC. Methods We included in the present prospective casecontrol study 50 consecutive patients admitted to our Hospital with a diagnosis of TTC according to the Mayo Clinic criteria. Fifty control patients with anterior STEMI matched for clinical characteristics such as age, gender, and hypertension were selected. During the hospitalization, all patients were asked to complete the Spielberger Trait Anxiety Inventory (STAI) scale for measuring self-reported trait anxiety (Trait-A). Outcome measures at follow-up were death, TTC recurrence, and rehospitalization. Results The mean value of STAI scale was 46 ± 12 in TTC patients and 45 ± 14 in STEMI patients (p = 0.815). High-anxiety trait (STAI scale value C 40) was documented in 30 (60%) TTC patients and in 26 (52%) STEMI patients (p = 0.387). At multivariate analysis, predictors of TTC were lower peak creatine kinase value (HR 0.999; 95% CI 0.998-0.999; p = 0.018) and an antecedent stressful trigger event (HR 45.487;; p = 0.001), but anxiety trait was not. There were no differences in outcome measures between TTC patients with or without high-anxiety trait. Conclusion In TTC patients, high-anxiety trait is a common finding but it is not significantly more frequent than in patients with STEMI. Moreover, a high-anxiety trait seems to be neither associated with a worse clinical outcome nor a predictor of TTC. Our study do not support the routine evaluation of anxiety trait in patients with TTC.

Cortisol awakening and stress response, personality and psychiatric profiles in patients with takotsubo cardiomyopathy

“…Psychological approaches to reveal the aetiology of TTC are sparse and reveal conflicting results 4 21. In the present study, TTC patients were screened in detail for predisposing attributes, but our findings neither lend support for psychiatric or personality characteristics nor for an increased occurrence of general social or work hassles.…”

Takotsubo cardiomyopathy: pathophysiology and treatment

“…Manfredini et al found that patients most frequently present on Mondays and argued that start of the week is associated with greater prevalence of stress 13. In contrast, a study by Del Pace et al found no difference in rates of anxiety between takotsubo cardiomyopathy and STEMI patients, rejecting anxiety as a potential trigger for takotsubo cardiomyopathy 14. Interestingly, Yaqub et al recently reported two distinct clinical phenotypes of takotsubo cardiomyopathy concluding that emotional stress-induced takotsubo cardiomyopathy required less intense haemodynamic support when compared with idiopathic/physical stress-induced takotsubo cardiomyopathy 15.…”

Psychological distress and personality factors in takotsubo cardiomyopathy

“…The prevalence of depression and anxiety disorders in TCC ranges from 21–60 % [1, 16–19]. An increase in levels of psychological distress from admission to one-year follow-up is common [20].…”