No myocardial vulnerability to mental stress in Takotsubo stress cardiomyopathy.
OBJECTIVE
Due 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.


METHODS
This study is a case-control study and a sub-study of the Stockholm Myocardial Infarction with Normal Coronaries (SMINC) study.


METHODS
Mental 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.


METHODS
Twenty-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.


RESULTS
There 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.


CONCLUSIONS
Mental 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.
Departments of Clinical Sciences and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
Olov
O
Collste
Departments of Clinical Sciences and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
Per
P
Tornvall
Department of Psychology, Mittuniversitetet, Östersund, Sweden.
Örjan
Ö
Sundin
Departments of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
Mahbubul
M
Alam
Departments of Clinical Sciences and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
Mats
M
Frick
D016022:Case-Control Studies; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D012463:Saliva / Q000378:metabolism; D013315:Stress, Psychological; D054549:Takotsubo Cardiomyopathy / Q000503:physiopathology / Q000523:psychology*
D006854:Hydrocortisone