Multidisciplinary assessment of tako tsubo cardiomyopathy: a prospective case study

Abstract

BackgroundThe cause of tako tsubo cardiomyopathy remains unclear. We used a multidisciplinary approach to investigate if a common pathophysiological denominator could be outlined.MethodsWithin 3 days following symptom presentation and again after 3 months we investigated all patients coming to our institution and diagnosed with tako-tsubo cardiomyopathy. Patients underwent extensive biochemical screening. Left ventricular function was evaluated by echocardiography and contrast-enhanced cardiac magnetic resonance imaging. Cardiac autonomic function was studied by heart rate variability and signal-averaged electrocardiogram and posttraumatic stress and depression were investigated by questionnaires (the Posttraumatic Stress Syndrome 10-Questions Inventory, PTSS-10 and the Montgomery-Åsberg depression rating scale, self rated version, MADRS-S).ResultsDuring 2 years, 13 consecutive patients were included. Markers of myocardial damage and heart failure were slightly to moderately elevated and ejection fraction (echocardiography and MRi) was moderately reduced at hospitalization and improved to normal values in all patients. Signal averaged ECG demonstrated a statistically significant shorter duration of the filtered QRS complex in the acute phase as compared to follow-up. In heart rate variability analysis, SDNN and SDANN were shorter acutely compared to follow-up. Two patients fulfilled criteria for posttraumatic stress syndrome while 7 patients were in the borderline zone. There was a statistically significant inverse correlation between PTSS-10 score and QRS duration in the signal-averaged ECG (r = -0.66, P = 0.01).ConclusionsPatients with tako tsubo cardiomyopathy have altered cardiac autonomic function and a high incidence rate of borderline or definite posttraumatic stress syndrome acutely. This is in line with findings in patients with myocardial infarction and does not allow conclusions on cause and effect.

Anxiodepressive Disorders and Chronic Psychological Stress Are Associated With Tako-Tsubo Cardiomyopathy

“…Waldenborg et al, in a prospective cohort study with systematic screening by psychiatric interview, did not find abnormal prevalence of major depressive disorder in a group of 13 patients with TTC. 15 Del Pace et al, in a recent prospective case-control study, found that high anxiety is a common trait in patients with TTC but is not more frequent than in those with acute myocardial infarction. 16 These results are surprising because several previous retrospective studies based on past psychiatric history and use of antidepressant medication suggested an increased prevalence of ADD in patients with TTC.…”

Heart Rate Variability as a Predictor of Death in Burn Patients

“…In another condition triggered by severe emotional or physical stress called Takotsubo cardiomyopathy, patients present with depressed left ventricular function, elevated troponin levels, and angiographically normal coronary arteries (24). HRV in this condition has been assessed by several groups who both found that HRV was depressed during the acute setting, but significantly increased after recovery (25, 26). Results of these studies suggest that HRV is a marker of autonomic dysregulation that occurs as a result of severe illness.…”

Recurrent Tako-Tsubo cardiomyopathy (TTC) in a pre-menopausal woman: late sequelae of a traumatic event?

“…The psycho-somatic connections underlying TTC are far from clear [ 14 , 15 , 39 ]. In a case study published recently in this journal, Waldenborg et al even proposed to avoid terms as “stress-induced cardiomyopathy” or “broken heart syndrome” for TTC [ 49 ]. They detected symptoms of acute posttraumatic stress in 9 out of 13 (69%) TTC patients (2 patients qualified for having PTSD) and similar numbers of acute distress can be found in patients with acute myocardial infarction [ 49 ].…”