Cumulative Impact of Stressful Life Events on the Development of Takotsubo Cardiomyopathy.

Abstract

The role of stressful life events in the onset of Takotsubo cardiomyopathy (TC) is unclear. This study sought to examine associations between type, timing, and number of stressful life events and onset of TC. A case-control study conducted among consecutive incident female TC cases and myocardial infarction (MI) controls admitted to two emergency departments in New England. Healthy female controls (HC) were recruited from a volunteers' registry. Information about the timing, type, and number of triggers during the 6months preceding hospitalization was systematically collected using the PERI Life Events Scale about 1month post-discharge. Group differences were evaluated using ANOVA, chi-square, and Kruskal-Wallis statistics. Generalized linear models were used to adjust for confounding variables. Between March 2013 and October 2015, 107 women were enrolled (45 TC, 32 MI, and 30 HC). Specific stressful events (death of a relative or close friend (p=0.006); illness or injury to a relative or close friend (p=0.001) were more prevalent in TC cases than MI and HC controls. The onset of TC was associated with exposure to multiple stressful life events during the 6months preceding the index hospitalization (p<0.001) but not with exposure to an acute, recent event (p=0.96). TC onset was associated with specific life events (death or illness to close relative or friend) and with the number of stressful life events occurring in the 6months preceding hospitalization. These findings suggest that grief and cumulative stress could play a major role in the onset of TC.