Abstract
Background
Stress-induced Tako-tsubo cardiomyopathy (TTC) is an acute cardiac syndrome, mimics ST elevation myocardial infarction (STEMI), largely confined to postmenopausal women, frequently precipitated by a stressful event. The pathogenesis of TTC is still unknown. Some authors hypothesized a possible connection between TTC and anxiety disease, but no previous study analyzed the relationship between anxiety trait and TTC. This study sought to assess the potential role of anxiety trait in the development and clinical course of TTC.
Methods
We included in the present prospective case–control study 50 consecutive patients admitted to our Hospital with a diagnosis of TTC according to the Mayo Clinic criteria. Fifty control patients with anterior STEMI matched for clinical characteristics such as age, gender, and hypertension were selected. During the hospitalization, all patients were asked to complete the Spielberger Trait Anxiety Inventory (STAI) scale for measuring self-reported trait anxiety (Trait-A). Outcome measures at follow-up were death, TTC recurrence, and rehospitalization.
Results
The mean value of STAI scale was 46 ± 12 in TTC patients and 45 ± 14 in STEMI patients (p = 0.815). High-anxiety trait (STAI scale value ≥ 40) was documented in 30 (60%) TTC patients and in 26 (52%) STEMI patients (p = 0.387). At multivariate analysis, predictors of TTC were lower peak creatine kinase value (HR 0.999; 95% CI 0.998–0.999; p = 0.018) and an antecedent stressful trigger event (HR 45.487; 95% CI 6.471–319.759; p = 0.001), but anxiety trait was not. There were no differences in outcome measures between TTC patients with or without high-anxiety trait.
Conclusion
In TTC patients, high-anxiety trait is a common finding but it is not significantly more frequent than in patients with STEMI. Moreover, a high-anxiety trait seems to be neither associated with a worse clinical outcome nor a predictor of TTC. Our study do not support the routine evaluation of anxiety trait in patients with TTC.
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References
Kurisu S, Sato H, Kawagoe T et al (2002) Tako-tsubo-like left ventricular dysfunction with ST-segment elevation: a novel cardiac syndrome mimicking acute myocardial infarction. Am Heart J 143:448–455
Prasad A, Lerman A, Rihal CS (2008) Apical Balloning syndrome (Tako-tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction. Am Heart J 155:408–417
Bybee KA, Kara T, Prasad A et al (2004) Systematic review: transient left ventricular apical ballooning: a syndrome that mimics ST-segment elevation myocardial infarction. Ann Int Med 141:858–865
Sharkey SW, Lesser JR, Zenovich AG et al (2005) Acute and reversible cardiomyopathy provoked by stress in women from the United States. Circulation 111:472–479
Bybee KA, Prasad A (2008) Stress-related cardiomyopathy syndromes. Circulation 118:397–409
Koeth O, Mark B, Kilkowski A et al (2008) Clin Res Cardiol 97:623–627
Parodi G, Del Pace S, Carrabba N et al (2007) Incidence, clinical findings and outcome of women with left ventricular apical ballooning syndrome. Am J Cardiol 99:182–185
Morilak DA, Barrera G, Echevarria DJ et al (2005) Role of brain norepinephrine in the behavioral response to stress. Prog Neuropsychopharmacol Biol Psychiarty 29:1214–1224
Tanaka M, Yoshida M, Emoto H, Ishii H (2000) Noradrenaline systems in the hypothalamus, amygdala and locus coeruleus are involved in the provocation of anxiety: basic studies. Eur J Pharmacol 405:397–406
Johnson MR, Lydiard RB (1995) The neurobiology of anxiety disorders. Psychiatr Clin North Am 18(4):681–725
Nguyen SB, Cevik C, Otahbachi M, Kumar A, Jenkins LA, Nugent K (2009) Do comorbid psychiatric disorders contributed to the pathogenesis of tako-tsubo syndrome? A review of the pathogenesis. Congest Heart Fail 15:31–34
Thygesen K, Alpert JS, White HD (2007) Universal definition of myocardial infarction. Eur Heart J 28:2525–2538
Wittstein IS, Thiemann DR, Lima JA et al (2005) Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med 352:539–548
Jiang W, Kuchibhatla M, Cuffe MS et al (2004) Prognostic value of anxiety and depression in patients with chronic heart failure. Circulation 110:3452–3456
Muller JE, Abela GS, Nesto RW, Tofler GH (1994) Triggers, acute risk factors and vulnerable plaques: the lexicon of a new frontier. J Am Coll Cardiol 23:809–813
Kurisu S, Inoue I, Kawagoe T et al (2003) Myocardial perfusion and fatty acid metabolism in patients with tako-tsubo-like left ventricular dysfunction. J Am Coll Cardiol 41:743–748
Bybee KA, Murphy J, Wright RS, Prasad A, Rihal CS, Chareonthaitawee P (2006) Acute impairment of regional myocardial glucose uptake in the apical ballooning (takotsubo) syndrome. J Nuc Cardiol 13:244–250
Moser DK (2007) The rust of life: impact of anxiety on cardiac patients. Am J Critical Care 16:361–369
Rothman KJ, Greenland S (1998) Modern epidemiology, vol 7, 2nd ed. Lippincott Williams & Wilkins, Philadelphia; pp 93–114
Lane D, Carroll D, Ring C, Beevers DG, Lip GY (2001) Mortality and quality of life 12 months after myocardial infarction: effects of depression and anxiety. Psychosom Med 63:221–230
Akimova E, Lanzenberger R, Kasper S (2009) The serotonin-1A receptor in anxiety disorders. Biol Psychiatry 66:627–635
De Berardis D, Serroni N, Carano A et al (2008) The role of duloxetine in the treatment of anxiety disorders. Neuropsychiatr Dis Treat 4:929–935
Stahl SM, Grady MM, Moret C, Briley M (2005) SNRIs: their pharmacology, clinical efficacy, and tolerability in comparison with other classes of antidepressants. CNS Spectr 10:732–747
Brunello N, Blier P, Judd LL, Mendlewicz J, Nelson CJ, Souery D, Zohar J, Racagni G (2003) Noradrenaline in mood and anxiety disorders: basic and clinical studies. Int Clin Psychopharmacol 18:191–202
Nutt DJ (2001) Neurobiological mechanism in generalized anxiety disorder. J Clinic Psychiatry 62(Suppl 11):22–27
Denollet J, Maas K, Knottnerus A, Keyzer JJ, Pop VJ (2009) Anxiety predicted premature all-cause and cardiovascular death in a 10 year follow-up of middle-aged women. J Clin Epidemiol 62:452–456
Jakobsen AH, Foldager L, Parker G, Munk-Jørgensen P (2008) Quantifying links between acute myocardial infarction and depression, anxiety and schizophrenia using case register database. J Affect Disord 109:177–181
Von Känel R, Kudielka BM, Haeberli A, Stutz M, Fischer JE, Patterson SM (2009) Prothrombotic changes with acute psychological stress: combined effect of hemoconcentration and genuine coagulation activation. Thromb Res 123:622–630
De Boer D, Ring C, Curlett AC, Ridley M, Carroll D (2007) Mental stress-induced hemoconcentration and its recovery: a controlled study of time course and mechanisms. Psychophysiology 44:161–169
Rozansky A, Blumenthal JA, Kaplan J (1999) Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation 99:2192–2197
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Del Pace, S., Parodi, G., Bellandi, B. et al. Anxiety trait in patients with stress-induced cardiomyopathy: a case–control study. Clin Res Cardiol 100, 523–529 (2011). https://doi.org/10.1007/s00392-010-0276-x
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DOI: https://doi.org/10.1007/s00392-010-0276-x