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Cumulative Impact of Stressful Life Events on the Development of Takotsubo Cardiomyopathy

  • Original Article
  • Published:
Annals of Behavioral Medicine

Abstract

Background

The role of stressful life events in the onset of Takotsubo cardiomyopathy (TC) is unclear.

Purpose

This study sought to examine associations between type, timing, and number of stressful life events and onset of TC.

Methods

A case-control study conducted among consecutive incident female TC cases and myocardial infarction (MI) controls admitted to two emergency departments in New England. Healthy female controls (HC) were recruited from a volunteers’ registry. Information about the timing, type, and number of triggers during the 6 months preceding hospitalization was systematically collected using the PERI Life Events Scale about 1 month post-discharge. Group differences were evaluated using ANOVA, chi-square, and Kruskal-Wallis statistics. Generalized linear models were used to adjust for confounding variables.

Results

Between March 2013 and October 2015, 107 women were enrolled (45 TC, 32 MI, and 30 HC). Specific stressful events (death of a relative or close friend (p = 0.006); illness or injury to a relative or close friend (p = 0.001) were more prevalent in TC cases than MI and HC controls. The onset of TC was associated with exposure to multiple stressful life events during the 6 months preceding the index hospitalization (p < 0.001) but not with exposure to an acute, recent event (p = 0.96).

Conclusions

TC onset was associated with specific life events (death or illness to close relative or friend) and with the number of stressful life events occurring in the 6 months preceding hospitalization. These findings suggest that grief and cumulative stress could play a major role in the onset of TC.

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References

  1. Templin C, Ghadri JR, Diekmann J, et al. Clinical features and outcomes of Takotsubo (stress) cardiomyopathy. N Engl J Med. 2015; 373: 929–38.

    Article  CAS  PubMed  Google Scholar 

  2. Dote K, Sato H, Tateishi H, Uchida T, Ishihara M. Myocardial stunning due to simultaneous multivessel coronary spasms: A review of 5 cases. J Cardiol. 1991; 21: 203–214.

    CAS  PubMed  Google Scholar 

  3. Gianni M, Dentali F, Grandi AM, Sumner G, Hiralal R, Lonn E. Apical ballooning syndrome or takotsubo cardiomyopathy: A systematic review. Eur Heart J. 2006; 27(13): 1523–1529.

    Article  PubMed  Google Scholar 

  4. Pilgrim TM, Wyss TR. Takotsubo cardiomyopathy or transient left ventricular apical ballooning syndrome: A systematic review. Int J Cardiol. 2008; 124: 283–292.

    Article  PubMed  Google Scholar 

  5. Yerasi C, Koifman E, Weissman G, et al. Impact of triggering event in outcomes of stress-induced (Takotsubo) cardiomyopathy. Eur Heart J Acute Cardiovasc Care. 2016; undefined.

  6. Delmas C, Lairez O, Mulin E, et al. Anxiodepressive disorders and chronic psychological stress are associated with Tako-Tsubo cardiomyopathy–new Physiopathological hypothesis. Circ J. 2013; 77: 175–180.

    Article  PubMed  Google Scholar 

  7. Wallstrom S, Ulin K, Maatta S, Omerovic E, Ekman I. Impact of long-term stress in Takotsubo syndrome: Experience of patients. Eur J Cardiovasc Nurs. 2015; undefined.

  8. Wittstein IS, Thiemann DR, Lima JA, et al. Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med. 2005; 352: 539–548.

    Article  CAS  PubMed  Google Scholar 

  9. Salmoirago-Blotcher E, Rosman L, Wittstein IS, et al. Psychiatric history, post-discharge distress, and personality characteristics among incident female cases of takotsubo cardiomyopathy: A case-control study. Heart Lung. 2016; 45: 503–509.

    Article  PubMed  Google Scholar 

  10. Prasad A, Lerman A, Rihal CS. Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): A mimic of acute myocardial infarction. Am Heart J. 2008; 155: 408–417.

    Article  PubMed  Google Scholar 

  11. Dohrenwend BS, Krasnoff L, Askenasy AR, Dohrenwend BP. Exemplification of a method for scaling life events: The Peri life events scale. J Health Soc Behav. 1978; 19: 205–229.

    Article  CAS  PubMed  Google Scholar 

  12. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.

  13. Fox E, Cahill S, Zougkou K. Preconscious processing biases predict emotional reactivity to stress. Biol Psychiatry. 2010; 67(4): 371–377.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Ghadri JR, Sarcon A, Diekmann J, et al. Happy heart syndrome: role of positive emotional stress in takotsubo syndrome. Eur Heart J. 2016; undefined.

  15. Buckley T, McKinley S, Tofler G, Bartrop R. Cardiovascular risk in early bereavement: A literature review and proposed mechanisms. Int J Nurs Stud. 2010; 47(2): 229–238.

    Article  PubMed  Google Scholar 

  16. Lee S, Colditz GA, Berkman LF, Kawachi I. Caregiving and risk of coronary heart disease in U.S. women: a prospective study. Am J Prev Med. 2003; 24(2): 113–119.

    Article  PubMed  Google Scholar 

  17. Grupe DW, Nitschke JB. Uncertainty and anticipation in anxiety: an integrated neurobiological and psychological perspective. Nat Rev Neurosci. 2013; 14(7): 488–501.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We wish to thank Sandhya Reddy, MD (data abstractor) and Ms. Nancy Mecone, BS, RN (research coordinator) for their collaboration on this study.

Author information

Authors and Affiliations

  1. Department of Medicine, Yale School of Medicine, New Haven, CT, USA

    Lindsey Rosman PhD

  2. Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA

    Shira Dunsiger PhD

  3. Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA

    Shira Dunsiger PhD

  4. Department of Medicine, Brown University Medical School and The Miriam Hospital, Providence, RI, USA

    Elena Salmoirago-Blotcher MD, PhD

Authors
  1. Lindsey Rosman PhD
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  2. Shira Dunsiger PhD
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  3. Elena Salmoirago-Blotcher MD, PhD
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Corresponding author

Correspondence to Lindsey Rosman PhD.

Ethics declarations

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Funding

This work was supported by an American Heart Association (Dallas, TX) award to Dr. Elena Salmoirago-Blotcher (Grant 13CRP1334001). The authors do not have relationships with the industry.

Authors’ Statement of Conflict of Interest and Adherence to Ethical Standards

Authors Lindsey Rosman and Shira Dunsiger declare that they have no conflict of interest. Elena Salmoirago-Blotcher, Md, PhD: this work was supported by American Heart Association (Dallas, TX) award 13CRP1334001 to Dr. Elena Salmoirago-Blotcher. The AHA did not have any role in the design and conduct of the study, in the collection, analysis, and interpretation of the data, and in the preparation, review, or approval of the manuscript. All procedures, including the informed consent process, were conducted in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.

Research Involving Human Participants and/or Animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Rosman, L., Dunsiger, S. & Salmoirago-Blotcher, E. Cumulative Impact of Stressful Life Events on the Development of Takotsubo Cardiomyopathy. ann. behav. med. 51, 925–930 (2017). https://doi.org/10.1007/s12160-017-9908-y

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  • DOI: https://doi.org/10.1007/s12160-017-9908-y

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