Abstract
ObjectivesDue to the frequent use of coronary angiography the awareness of Takotsubo stress cardiomyopathy (TSC) has increased although the exact pathophysiology of TSC is still largely unknown. Our objective was to investigate the effects of mental stress on myocardial function, heart rate variability (HRV) and salivary cortisol (SC) in TSC patients.DesignThis study is a case-control study and a sub-study of the Stockholm Myocardial Infarction with Normal Coronaries (SMINC) study.SettingMental stress test was performed more than 6 months after the acute event in TSC patients and age- and sex-matched controls. Standard echocardiography and tissue Doppler imaging (TDI) - derived time-phases of cardiac cycle were recorded to calculate myocardial performance index (MPI) to assess ventricular function before and during mental stress. Holter-ECG recording was made to estimate HRV before, during and after mental stress. SC was measured at baseline, before and 20 minutes after mental stress.SubjectsTwenty-two TSC patients and 22 sex-and age-matched controls were recruited from the SMINC-study and investigated with a mental stress test. All TSC patients had a previous normal cardiovascular magnetic resonance investigation.ResultsThere were no significant differences at rest or during mental stress for left and right ventricular MPI or other standard diastolic variables between TSC patients and controls. HRV did not differ between TSC patients and controls. There was a trend towards less increase in SC after mental stress in TSC patients compared to controls.ConclusionMental stress did not induce a significant difference in myocardial function or HRV response between TSC and controls. Moreover, no significant difference could be seen in SC response at baseline, during or after mental stress. This study indicates that myocardial vulnerability to mental stress does not persist in TSC patients.
Highlights
Takotsubo stress cardiomyopathy (TSC) is an important subgroup of myocardial infarction with normal coronary arteries (MINCA)
Mental stress did not induce a significant difference in myocardial function or heart rate variability (HRV) response between TSC and controls
This study indicates that myocardial vulnerability to mental stress does not persist in TSC patients
Summary
Takotsubo stress cardiomyopathy (TSC) is an important subgroup of myocardial infarction with normal coronary arteries (MINCA). It was shown that MINCA occured in as many as 7–8% of all patients with acute coronary syndrome [1]. Case studies have reported TSC occurring during dobutamine stress echocardiography (DSE) [3,4]. A recent study on the effect of DSE in patients with a previous episode of TSC could not show a difference in tissue doppler imaging (TDI) variables during stress [5]. Most episodes of TSC are precipitated by mental stress [6] the effect of mental stress on left and right ventricular function in TSC patients after the acute event is unknown. Since MPI is a sensitive marker of ventricular function it is valuable in evaluating effects of mental stress [7]
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