title: Cortisol awakening and stress response, personality and psychiatric profiles in patients with takotsubo cardiomyopathy.
abstract: OBJECTIVE
  Alterations in cortisol awakening and stress responses (CAR, CSR) are sensitive markers for the basal activity and responsiveness of the hypothalamus-pituitary-adrenal axis (HPAA) in psychopathological conditions. We investigated whether patients with takotsubo cardiomyopathy (TTC) differ in these markers when compared with non-ST-segment elevation myocardial infarction (NSTEMI) patients and healthy controls.
  
  
  METHODS
  19 female TTC patients were compared with 20 female NSTEMI patients and with 20 healthy women, matched by age and index event date. Salivary sampling indicated cortisol release, questionnaires assessed personality, life events, chronic stress and psychiatric symptoms.
  
  
  RESULTS
  The groups did not differ relevantly in their basal HPAA activity, psychiatric or personality profiles. Despite increased heart rates in response to stress (median difference (MDdiff)=3.5, p=0.002) and higher nervousness scores (MDdiff=-3.0, p=0.024), TTC patients revealed a blunted CSR with a medium effect compared to the controls (MDdiff=-3.2 nmol/L, p=0.022, r=0.36); even when controlled for prestress cortisol differences (p=0.044, r=0.33). In comparison with NSTEMI patients, no significant differences in CSR (MDdiff=-1.9 nmol/L, p=0.127, r=0.25) or nervousness (MDdiff=2.0, p=0.107) can be observed. Stressful life events, for example, traumatic experiences, occurred more often in TTC (42%) than in NSTEMI patients and controls (both 10%, p=0.031).
  
  
  CONCLUSIONS
  In this small exploratory trial, a trend for a blunted CSR and high incidences of stressful life events were observed in TTC patients. If these results can be confirmed in larger studies, chronic stress and the inhibitory influence of cortisol on catecholamine release might be significant for the pathogenesis of TTC.
authors.affiliation: Department of Neurology, Heart & Brain Research Group, University Hospital Giessen and Marburg, Giessen, Germany Department of Heart Surgery, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Kastaun
authors.affiliation: Department of Neurology, Heart & Brain Research Group, University Hospital Giessen and Marburg, Giessen, Germany.
authors.forename: Niko P
authors.initials: NP
authors.lastname: Schwarz
authors.affiliation: Department of Neurology, Heart & Brain Research Group, University Hospital Giessen and Marburg, Giessen, Germany Department of Neurology, Buergerhospital Friedberg, Friedberg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Juenemann
authors.affiliation: Department of Neurology, Heart & Brain Research Group, University Hospital Giessen and Marburg, Giessen, Germany Department of Neurology, Buergerhospital Friedberg, Friedberg, Germany.
authors.forename: Mesut
authors.initials: M
authors.lastname: Yeniguen
authors.affiliation: Department of Cardiology, University Hospital Giessen and Marburg, Giessen, Germany.
authors.forename: Holger M
authors.initials: HM
authors.lastname: Nef
authors.affiliation: Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.
authors.forename: Helge
authors.initials: H
authors.lastname: Moellmann
authors.affiliation: Department of Cardiology, University Hospital Giessen and Marburg, Giessen, Germany Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.
authors.forename: Christian W
authors.initials: CW
authors.lastname: Hamm
authors.affiliation: Department of Psychiatry, University Hospital Giessen and Marburg, Giessen, Germany.
authors.forename: Gebhard
authors.initials: G
authors.lastname: Sammer
authors.affiliation: Department of Psychology, Personality Psychology and Individual Differences, Justus Liebig University, Giessen, Germany.
authors.forename: Juergen
authors.initials: J
authors.lastname: Hennig
authors.affiliation: Department of Neurology, Heart & Brain Research Group, University Hospital Giessen and Marburg, Giessen, Germany Department of Radiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Bachmann
authors.affiliation: Department of Neurology, Heart & Brain Research Group, University Hospital Giessen and Marburg, Giessen, Germany Department of Neurology, Buergerhospital Friedberg, Friedberg, Germany.
authors.forename: Tibo
authors.initials: T
authors.lastname: Gerriets
mesh_terms: D000328:Adult; D017677:Age Distribution; D000704:Analysis of Variance; D016022:Case-Control Studies; D018450:Disease Progression; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis / Q000378:metabolism*; D015994:Incidence; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology*; D010551:Personality; D010913:Pituitary-Adrenal System / Q000503:physiopathology*; D011379:Prognosis; D011594:Psychometrics; D018570:Risk Assessment; D012720:Severity of Illness Index; D013315:Stress, Psychological; D054549:Takotsubo Cardiomyopathy / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology*
chemical_list: D006854:Hydrocortisone
keywords: cortisol stress response; personality; psychiatric disorders