Delayed-Type Hypersensitivity to Metals of Environmental Burden in Patients with Takotsubo Syndrome - Is There a Clinical Relevance?
OBJECTIVE
Takotsubo syndrome (TS) is a heart condition characterised by a sudden transient left ventricular dysfunction; its pathophysiology is probably associated with elevated levels of catecholamines but the exact mechanism is not known as yet. Literature and clinical experience suggest that TS affects persons with various comorbidities. This pilot work aims to evaluate the frequency of comorbidities with potential pathological immune reactivity, and to evaluate the potential association between TS and hypersensitivity to metals assessed by LTT-MELISA®.
A total of 24 patients (23 women, 1 man) with a history of TS attack and 27 healthy controls were evaluated. Hypersensitivity was evaluated by a lymphocyte transformation test (LTT-MELISA®); a questionnaire of environmental burden was used to select evaluated metals. A total of 19 patients (79%) had at least one condition that might potentially be associated with pathological immune reactivity (autoimmune thyroid disease, drug allergy, bronchial asthma, cancer, contact dermatitis, rheumatoid arthritis). Hypersensitivity to metals was identified significantly more frequently in TS patients than in healthy controls (positive reaction to at least one metal was identified in 95.8% of TS patients and in 59.3% of controls; p = 0.003); the difference was statistically significant for mercury (45.8% and 14.8%, respectively; p = 0.029).


CONCLUSIONS
Our work shows that conditions with pathological immune reactivity occur frequently in TS patients, and our data suggest a possible association between TS and hypersensitivity to metals (mercury in particular) evaluated by LTT-MELISA®. We also suggest that apart from the triggering stress factor, potential existence of other serious conditions should be considered when taking medical history of TS patients.
Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic.
Jan
J
Manousek
Department of Molecular Biosciences, The Wenner-Gren Institute, Stockholm University, Stockholm, Sweden.|Research Centre for Toxic Compounds in the Environment (RECETOX), Faculty of Science, Masaryk University, Brno, Czech Republic.
Vera
V
Stejskal
Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic.
Petr
P
Kubena
Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
Jiri
J
Jarkovsky
Centre of Cardiovascular Surgery and Transplantations, Brno, Czech Republic.|Faculty of Medicine, Masaryk University, Brno, Czech Republic.
Petr
P
Nemec
Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic.|Faculty of Medicine, Masaryk University, Brno, Czech Republic.
Petr
P
Lokaj
Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic.
Ludmila
L
Dostalova
Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic.
Andrea
A
Zadakova
Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic.|Faculty of Medicine, Masaryk University, Brno, Czech Republic.
Marie
M
Pavlusova
Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
Klara
K
Benesova
Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic.|Faculty of Medicine, Masaryk University, Brno, Czech Republic.
Petr
P
Kala
Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic.
Roman
R
Miklik
Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic.|Faculty of Medicine, Masaryk University, Brno, Czech Republic.
Jindrich
J
Spinar
Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic.|Faculty of Medicine, Masaryk University, Brno, Czech Republic.
Jiri
J
Parenica
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000276:immunology; D004342:Drug Hypersensitivity / Q000276:immunology; D004777:Environment; D005260:Female; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000276:immunology*; D008213:Lymphocyte Activation / Q000276:immunology; D008297:Male; D008628:Mercury / Q000276:immunology; D008670:Metals / Q000276:immunology*; D008875:Middle Aged; D010865:Pilot Projects; D054549:Takotsubo Cardiomyopathy / Q000276:immunology*
D008670:Metals; D008628:Mercury