title: Platelet function in Takotsubo cardiomyopathy.
abstract: Takotsubo cardiomyopathy (TK) includes a transient left ventricular dysfunction without obstructive coronary disease, sometimes after stressful situations with elevated cathecolamines. Since catecholamines activate platelets we aimed to study the platelet influence in a TK setting. We included 32 patients with a TK diagnosis, 13 with an acute coronary syndrome (ACS) and 18 healthy volunteers. Once consent informed was obtained, blood samples were extracted and processed (at admission and after 3 months follow-up). Clinical, ecg, echocardiographic and angiographic features were thoroughly recorded.Previous treatment before admission was similar between groups. No differences were observed in clinical features or any of the acute markers studied regarding platelet reactivity between TK compared to ACS. After follow-up, aggregation levels and platelet reactivity showed differences, mainly due to the antithrombotic therapy prescribed at discharge, but similar to volunteers. Circulating epinephrine during the acute phase was significantly higher in TK (p < 0.001). Patients with higher levels of epinephrine had elevated platelet activation and aggregation after 3 months. No differences were observed in Takotsubo acute platelet aggregation compared to patients with ACS, in spite of higher blood levels of adrenaline. Takotsubo patients had elevated platelet aggregation and activation compared with ACS patients at 3 months follow-up because they were less frequently on chronic clopidogrel and ASA. However, they had similar platelet aggregation and activation levels to healthy volunteers despite treatment with low-dose ASA. Takotsubo patients who had higher levels of adrenaline in the acute phase displayed increased platelet reactivity during follow-up.
authors: Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain, ibnsky@yahoo.es.
authors: Iván J
authors: IJ
authors: Núñez-Gil
authors: Esther
authors: E
authors: Bernardo
authors: Gisela
authors: G
authors: Feltes
authors: Javier
authors: J
authors: Escaned
authors: Hernán D
authors: HD
authors: Mejía-Rentería
authors: José Alberto
authors: JA
authors: De Agustín
authors: David
authors: D
authors: Vivas
authors: Luis
authors: L
authors: Nombela-Franco
authors: Pilar
authors: P
authors: Jiménez-Quevedo
authors: Carlos
authors: C
authors: Macaya
authors: Antonio
authors: A
authors: Fernández-Ortiz
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000188:drug therapy; D000368:Aged; D000369:Aged, 80 and over; D001792:Blood Platelets / Q000378:metabolism*; D000077144:Clopidogrel; D004837:Epinephrine / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010974:Platelet Aggregation; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D010979:Platelet Function Tests; D011446:Prospective Studies; D012042:Registries; D054549:Takotsubo Cardiomyopathy / Q000097:blood* / Q000188:drug therapy; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D004837:Epinephrine