title: Stress-induced hyperviscosity in the pathophysiology of takotsubo cardiomyopathy.
abstract: Takotsubo cardiomyopathy (TC) is characterized by transient hypokinesis of the left ventricular apex or midventricular segments with coronary arteries without significant stenosis. It is often associated with emotional or physical stress; however, its pathophysiology is still unclear. In the present study, we analyzed the alterations in blood viscosity and markers of endothelial damage induced by sympathetic stimulation in patients with previous TC. Seventeen women (mean age 71 years) with previous TC, included and investigated in the TC Tuscany Registry, were compared to a control group of 8 age- and risk factor-matched women with chest pain and coronary arteries free of stenosis. All subjects underwent the cold pressor test (CPT). Before and after the CPT, the hemorheologic parameters (whole blood viscosity at 0.512 s(-1) and 94.5 s(-1), plasma viscosity, erythrocyte deformability index, and erythrocyte aggregation), catecholamines, plasminogen activator inhibitor-1 (PAI-1), and von Willebrand factor levels were assessed. The patients with TC had significantly greater baseline PAI-1 levels (p <0.01) and lower erythrocyte deformability index values (p <0.01). After CPT, both the patients with TC and the controls had a significant increase in several hemorheologic parameters, catecholamines, and von Willebrand factor levels and a decrease in erythrocyte deformability index. However, the PAI-1 levels were significantly increased only in the patients with TC. Compared to the controls, the patients with TC had significantly greater values of whole blood viscosity at 94.5 s(-1) (p <0.05), PAI-1 (p <0.01), von Willebrand factor (p <0.05) and lower erythrocyte deformability index values (p <0.01) after CPT. In conclusion, the results of the present study suggest that in patients with TC, the alterations in erythrocyte membranes and endothelial integrity induced by catecholaminergic storm could determine microvascular hypoperfusion, possibly favoring the occurrence of left ventricular ballooning.
authors: Department of Heart and Vessels, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. emanuelececchi@virgilio.it
authors: Emanuele
authors: E
authors: Cecchi
authors: Guido
authors: G
authors: Parodi
authors: Cristina
authors: C
authors: Giglioli
authors: Silvia
authors: S
authors: Passantino
authors: Brunella
authors: B
authors: Bandinelli
authors: Agatina Alessandrello
authors: AA
authors: Liotta
authors: Benedetta
authors: B
authors: Bellandi
authors: Gabriele
authors: G
authors: Cioni
authors: Maria
authors: M
authors: Costanzo
authors: Rosanna
authors: R
authors: Abbate
authors: Gian Franco
authors: GF
authors: Gensini
authors: Davide
authors: D
authors: Antoniucci
authors: Lucia
authors: L
authors: Mannini
mesh_terms: D000368:Aged; D001809:Blood Viscosity / Q000502:physiology*; D004730:Endothelium, Vascular / Q000503:physiopathology; D004903:Erythrocyte Aggregation / Q000502:physiology*; D004909:Erythrocyte Indices; D005260:Female; D006801:Humans; D012189:Retrospective Studies; D012307:Risk Factors; D013315:Stress, Psychological / Q000097:blood* / Q000150:complications / Q000503:physiopathology; D054549:Takotsubo Cardiomyopathy / Q000097:blood* / Q000150:complications / Q000503:physiopathology; D014661:Vasoconstriction / Q000502:physiology*