title: Autonomic function in Takotsubo syndrome long after the acute phase.
abstract: OBJECTIVE
  Although it is well documented that an exaggerated sympathetic stimulation plays a role in the development of Takotsubo Syndrome (TS) during the acute phase, only few studies have focused on autonomic adaptations in stress-induced cardiomyopathy long after the acute phase. Aim of the study was to investigate whether an impairment of the autonomic function is still present long after a TS event. This was done by comparing the response to a maximal exercise test in TS patients after apparent recovery (>1-year after the acute event) with that obtained in healthy subjects and in post-myocardial infarction (post-MI) patients.
  
  
  METHODS
  To assess heart rate recovery (HRR) and chronotropic response (CR), 24 TS patients, 25 healthy subjects and 22 post-MI patients underwent maximal exercise test, after at least 3 days of β-blockers wash-out.
  
  
  RESULTS
  HRR in TS patients (19.2±9.7bpm) was lower than in healthy subjects (27.7±8.3, p=0.003), and similar to post-MI patients (19.3±8.4; p=0.99). A decreasing CR trend (p=0.06), higher in healthy subjects (72±13%) than in TS (65±22%) and post-MI (57±21%) patients, was also found.
  
  
  CONCLUSIONS
  Compared to healthy subjects, TS patients showed a blunted parasympathetic reactivation after exercise, similar to that observed in post-MI patients, thereby suggesting that vagal control of heart rate after exercise is abnormal long after the acute presentation of TS.
authors.affiliation: Vascular and Cardio-thoracic Department, San Raffaele Scientific Institute, Vita-Salute University San Raffaele, Milan, Italy; Cardiovascular Prevention and Rehabilitation Unit, Don Carlo Gnocchi Foundation, Parma, Italy. Electronic address: davide.lazzeroni@gmail.com.
authors.forename: Davide
authors.initials: D
authors.lastname: Lazzeroni
authors.affiliation: Department of Clinical and Experimental Medicine, University of Parma, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Bini
authors.affiliation: IRCCS Fondazione Don C. Gnocchi, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Castiglioni
authors.affiliation: Department of Clinical and Experimental Medicine, University of Parma, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Moderato
authors.affiliation: Cardiovascular Prevention and Rehabilitation Unit, Don Carlo Gnocchi Foundation, Parma, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Ciraci'
authors.affiliation: Cardiovascular Prevention and Rehabilitation Unit, Don Carlo Gnocchi Foundation, Parma, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Camaiora
authors.affiliation: Cardiovascular Prevention and Rehabilitation Unit, Don Carlo Gnocchi Foundation, Parma, Italy.
authors.forename: Pietro Tito
authors.initials: PT
authors.lastname: Ugolotti
authors.affiliation: Cardiovascular Prevention and Rehabilitation Unit, Don Carlo Gnocchi Foundation, Parma, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Brambilla
authors.affiliation: Cardiovascular Prevention and Rehabilitation Unit, Don Carlo Gnocchi Foundation, Parma, Italy.
authors.forename: Valerio
authors.initials: V
authors.lastname: Brambilla
authors.affiliation: Cardiovascular Prevention and Rehabilitation Unit, Don Carlo Gnocchi Foundation, Parma, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Castrichini
authors.affiliation: Division of Cardiology, San Giovanni Bosco Hospital, Torino, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Ugo
authors.affiliation: Department of Cardiology, Parma University Hospital, Parma, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Gaibazzi
authors.affiliation: Department of Clinical and Experimental Medicine, University of Parma, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Coruzzi
mesh_terms: D000208:Acute Disease; D000368:Aged; D001341:Autonomic Nervous System / Q000503:physiopathology*; D004562:Electrocardiography; D015444:Exercise / Q000502:physiology; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D054549:Takotsubo Cardiomyopathy / Q000175:diagnosis / Q000503:physiopathology*; D013997:Time Factors
keywords: Autonomic nervous system; Exercise stress test; Heart rate recovery; Myocardial infarction; Takotsubo syndrome