title: Emotional, neurohormonal, and hemodynamic responses to mental stress in Tako-Tsubo cardiomyopathy.
abstract: Tako-Tsubo cardiomyopathy (TTC) is characterized by apical ballooning of the left ventricle and symptoms and signs mimicking acute myocardial infarction. The high catecholamine levels in the acute phase of TTC and common emotional triggers suggest a dysregulated stress response system. This study examined whether patients with TTC show exaggerated emotional, neurohormonal, and hemodynamic responses to mental stress. Patients with TTC (n = 18; mean age 68.3 ± 11.7, 78% women) and 2 comparison groups (healthy controls, n = 19; mean age 60.0 ± 7.6, 68% women; chronic heart failure, n = 19; mean age 68.8 ± 10.1, 68% women) performed a structured mental stress task (anger recall and mental arithmetic) and low-grade exercise with repeated assessments of negative emotions, neurohormones (catecholamines: norepinephrine, epinephrine, dopamine, hypothalamic-pituitary-adrenal axis hormones: adrenocorticotropic hormone [ACTH], cortisol), echocardiography, blood pressure, and heart rate. TTC was associated with higher norepinephrine (520.7 ± 125.5 vs 407.9 ± 155.3 pg/ml, p = 0.021) and dopamine (16.2 ± 10.3 vs 10.3 ± 3.9 pg/ml, p = 0.027) levels during mental stress and relatively low emotional arousal (p <0.05) compared with healthy controls. During exercise, norepinephrine (511.3 ± 167.1 vs 394.4 ± 124.3 pg/ml, p = 0.037) and dopamine (17.3 ± 10.0 vs 10.8 ± 4.1 pg/ml, p = 0.017) levels were also significantly higher in patients with TTC compared with healthy controls. In conclusion, catecholamine levels during mental stress and exercise were elevated in TTC compared with healthy controls. No evidence was found for a dysregulated hypothalamic-pituitary-adrenal axis or hemodynamic responses. Patients with TTC showed blunted emotional arousal to mental stress. This study suggests that catecholamine hyper-reactivity and not emotional hyper-reactivity to stress is likely to play a role in myocardial vulnerability in TTC.
authors.affiliation: Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, The Netherlands. Electronic address: l.smeijers@tilburguniversity.edu.
authors.forename: Loes
authors.initials: L
authors.lastname: Smeijers
authors.affiliation: Department of Cardiology, Elisabeth TweeSteden Hospital, Tilburg, The Netherlands.
authors.forename: Balázs M
authors.initials: BM
authors.lastname: Szabó
authors.affiliation: Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, The Netherlands; Department of Epidemiology, University Medical Center Groningen, The Netherlands.
authors.forename: Lotte
authors.initials: L
authors.lastname: van Dammen
authors.affiliation: Department of Cardiology, Elisabeth TweeSteden Hospital, Tilburg, The Netherlands.
authors.forename: Wally
authors.initials: W
authors.lastname: Wonnink
authors.affiliation: Department of Clinical Chemistry and Haematology, Elisabeth TweeSteden Hospital, Tilburg, The Netherlands.
authors.forename: Bernadette S
authors.initials: BS
authors.lastname: Jakobs
authors.affiliation: Department of Clinical Psychology, University of Amsterdam, The Netherlands.
authors.forename: Jos A
authors.initials: JA
authors.lastname: Bosch
authors.affiliation: Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, The Netherlands.
authors.forename: Willem J
authors.initials: WJ
authors.lastname: Kop
mesh_terms: D000368:Aged; D004644:Emotions; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D018377:Neurotransmitter Agents / Q000097:blood*; D013315:Stress, Psychological / Q000097:blood* / Q000150:complications / Q000503:physiopathology*; D054549:Takotsubo Cardiomyopathy / Q000097:blood* / Q000150:complications / Q000503:physiopathology* / Q000523:psychology
chemical_list: D018377:Neurotransmitter Agents