Abstract
ObjectiveTakotsubo syndrome (TTS) is a transient heart disease that has been historically related to the occurrence of psychological (emotional) factors (“broken heart” syndrome). We aimed to conduct a systematic review analyzing the role of psychological factors in TTS.MethodsAll studies on TTS and psychological factors from January 1991 through April 2019 were scrutinized according to the Cochrane Collaboration and the PRISMA statements. Selected studies were additionally evaluated for the Risk of Bias according to the Newcastle-Ottawa Scale (NOS).ResultsFifteen case-control studies (by Mayo Clinic criteria) were finally selected. Most studies analyzed stressful life-events or trauma, although with conflicting findings, while a likely role of long-lasting psychological distress seemed to be a homogenous result. Among life-time psychopathology, only anxiety appeared to have a significant role. Some studies outlined a likely role of personality, but findings are conflicting.ConclusionOur findings do not lead to any definitive assumption on the specific role of psychological factors in TTS, also for scant strong methodology of the most part of the studies. More studies with stronger research methodology are needed to better characterize psychological elements in TTS.
Highlights
Takotsubo syndrome (TTS) is a form of transient heart failure syndrome often mimicking acute myocardial infarction
Some studies outlined a likely role of personality, but findings are conflicting
Our findings do not lead to any definitive assumption on the specific role of psychological factors in TTS, for scant strong methodology of the most part of the studies
Summary
Takotsubo syndrome (TTS) is a form of transient heart failure syndrome often mimicking acute myocardial infarction. It is known as stress cardiomyopathy, broken heart syndrome, or apical ballooning syndrome, and was firstly described in 1990 (Dote et al, 1991), even if some Authors dated it earlier (Wittstein, 2008). Takotsubo syndrome is characterized by acute, but reversible, left ventricular regional systolic dysfunction accompanied by electrocardiographic changes and cardiac biomarkers elevation in the absence of a significant pathological condition (Wittstein, 2008). The estimated prevalence of TTS is about 1–3% of all patients presenting with suspected acute coronary syndrome and up to 5–6% in female patients (Ghadri et al, 2018), it is predominantly observed in postmenopausal women and elderly. The pathophysiological mechanisms responsible for TTS are complex and may vary between patients (Agewall et al, 2017) The prognosis is generally good (Agewall et al, 2017)
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