A broken heart: repair needed?

Abstract

At the recent meeting of the American Heart Association (Orlando, Florida, USA, November 2011) two interesting studies on a broken heart were presented. The first study was conducted by Dr. Abhishek Deshmukh at the University of Arkansas, USA and addressed patients with Takotsubo cardiomyopathy, also known as the broken heart syndrome [1, 2]. It was shown that women are 7–9 times more likely to suffer from the broken heart syndrome than men. Takotsubo cardiomyopathy may happen when sudden or prolonged stress such as an emotional breakup or death causes overwhelming heart failure or heart attack-like symptoms. The syndrome was first recognised about 20 years ago by physicians in Japan and occurs when a great emotional shock, even a positive one, induces a burst of adrenaline and other stress hormones that cause the left ventricle to balloon suddenly with ensuing cardiac dysfunction. The Arkansas University study analysed records from a nationwide database in 2007. It was found that of 6230 patients with broken heart syndrome, 90% were women. In addition, in patients over 55 years, the chance of developing broken heart syndrome was 9.5 times higher in women than in men. Consequently, hormonal differences or coronary artery variations may act as causative mechanisms. Fortunately, almost all patients with Takotsubo cardiomyopathy recovered spontaneously without permanent cardiac damage in need of (aggressive) repair. The second study on a broken heart, the Stem Cell Infusion in Patients with Ischemic cardiomyopathy (SCIPIO) study, was presented by Dr. Roberto Bolli (Louisville, Kentucky, USA). The study was conducted in patients with ischaemic cardiomyopathy and addressed the question whether patients’ own stem cells may be used to reverse cardiac damage. The SCIPIO study is an ongoing clinical trial which addressed post-MI patients who received infusions with cardiac stem cells that had been harvested from their own hearts during coronary artery bypass surgery. Patients with post-MI left ventricular dysfunction (LVEF ≤40%) before bypass surgery were randomly assigned to treatment or the control group (2:3 ratio). One million autologous cardiac stem cells were administered by intracoronary infusion 4 months after bypass surgery, whereas the control group received no treatment. The primary endpoint was short-term safety of cardiac stem cells and the secondary endpoint was feasibility. Sixteen patients were assigned to the treatment group and seven to the control group. In 14 patients with ischaemic cardiomyopathy who underwent bypass surgery, LVEF improved from 30.3% to 38.5% (P = 0.001), whereas in seven control patients the LVEF did not change (30.1% vs. 30.2 ± 2.5%). In seven stem cell patients who underwent cardiac MRI, the investigators observed a significant 24% decrease in infarct size at 4 months. It was concluded that intracoronary infusion of autologous cardiac stem cells was effective in improving left ventricular function and reducing infarct size in patients with heart failure after myocardial infarction. The results of the SCIPIO trial were published in The Lancet by Early Online Publication, on 14 November 2011. The data of the SCIPIO trial are encouraging and suggest that, if the correct cell type is used, this approach may be effective in patients with reduced cardiac function. The SCIPIO trial is the first study of autologous cardiac stem cells in humans. However, data are based on an interim analysis from an ongoing study and additional patients and follow-up will be needed to confirm these impressive preliminary results [3–5]. Anyway, the afore-mentioned studies show that broken hearts are capable of repair, be it spontaneously (Takotsubo cardiomyopathy) or by using cardiac stem cells (ischaemic cardiomyopathy).