title: Abnormal response to mental stress in patients with Takotsubo cardiomyopathy detected by gated single photon emission computed tomography.
abstract: OBJECTIVE
  Persistent abnormalities are usually not detected in patients with Takotsubo cardiomyopathy (TTC). Since sympathetically mediated myocardial damage has been proposed as a causative mechanism of TTC, we explored whether mental stress could evoke abnormalities in these patients.
  
  
  METHODS
  One month after an acute event, 22 patients fulfilling all TTC diagnostic criteria and 11 controls underwent resting and mental stress gated single photon emission computed tomography (SPECT). Perfusion, wall motion, transient ischaemic dilation (TID) and left ventricular (LV) ejection fraction (EF) were evaluated.
  
  
  RESULTS
  None of the controls showed stress-induced abnormalities. Mental stress evoked regional changes (perfusion defects and/or wall motion abnormality) in 16 TTC subjects and global abnormalities (LVEF fall >5% and/or TID >1.10) in 13; 3 had a completely negative response. TID, delta LVEF and delta wall motion score were significantly different in TTC vs control patients: 1.08 + or - 0.20 vs 0.95 + or - 0.11 (p < 0.05), -1.7 + or - 6% vs 4 + or - 5% (p < 0.02) and 2.5 (0, 4.25) vs 0 (0, 0) (p < 0.002), respectively.
  
  
  CONCLUSIONS
  Mental stress may evoke regional and/or global abnormalities in most TTC patients. The abnormal response to mental stress supports the role of sympathetic stimulation in TTC. Mental stress could thus be helpful for TTC evaluation.
authors.affiliation: Nuclear Medicine Unit, Department of Clinical Physiopathology, University of Florence, Viale Morgagni 85, 50134 Florence, Italy. r.sciagra@dfc.unifi.it
authors.forename: Roberto
authors.initials: R
authors.lastname: Sciagrà
authors.forename: Guido
authors.initials: G
authors.lastname: Parodi
authors.forename: Stefano
authors.initials: S
authors.lastname: Del Pace
authors.forename: Sabrina
authors.initials: S
authors.lastname: Genovese
authors.forename: Linda
authors.initials: L
authors.lastname: Zampini
authors.forename: Benedetta
authors.initials: B
authors.lastname: Bellandi
authors.forename: Gian Franco
authors.initials: GF
authors.lastname: Gensini
authors.forename: Alberto
authors.initials: A
authors.lastname: Pupi
authors.forename: David
authors.initials: D
authors.lastname: Antoniucci
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000786:Anger; D055426:Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography; D015897:Comorbidity; D005260:Female; D006801:Humans; D007092:Imagination; D008297:Male; D008875:Middle Aged; D009038:Motion; D055414:Myocardial Perfusion Imaging; D013060:Speech; D013315:Stress, Psychological / Q000503:physiopathology*; D013318:Stroke Volume; D013564:Sympathetic Nervous System / Q000503:physiopathology*; D054549:Takotsubo Cardiomyopathy / Q000523:psychology*; D014664:Vasodilation