Takotsubo cardiomyopathy (TC) often occurs after emotional or physical stress. Norepinephrine
levels are unusually high in the acute phase, suggesting a hyperadrenergic mechanism.
Comparatively little is known about parasympathetic function in patients with TC.
We sought to characterize autonomic function at rest and in response to physical and
emotional stimuli in 10 women with a confirmed history of TC and 10 age-matched healthy
women. Sympathetic and parasympathetic activity was assessed at rest and during baroreflex
stimulation (Valsalva maneuver and tilt testing), cognitive stimulation (Stroop test),
and emotional stimulation (event recall, patients). Ambulatory blood pressure monitoring
and measurement of brachial artery flow–mediated vasodilation were also performed.
TC women (tested an average of 37 months after the event) had excessive pressor responses
to cognitive stress (Stroop test: p <0.001 vs baseline and p = 0.03 vs controls) and
emotional arousal (recall of TC event: p = 0.03 vs baseline). Pressor responses to
hemodynamic stimuli were also amplified (Valsalva overshoot: p <0.05) and prolonged
(duration: p <0.01) in the TC women compared with controls. Plasma catecholamine levels
did not differ between TC women and controls. Indexes of parasympathetic (vagal) modulation
of heart rate induced by respiration and cardiovagal baroreflex gain were significantly
decreased in the TC women versus controls. In conclusion, even long after the initial
episode, women with previous episode of TC have excessive sympathetic responsiveness
and reduced parasympathetic modulation of heart rate. Impaired baroreflex control
may therefore play a role in TC.
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Article Info
Publication History
Published online: November 05, 2015
Accepted:
October 14,
2015
Received in revised form:
October 14,
2015
Received:
August 20,
2015
Footnotes
Funding Source: This study was funded by Fears, et al v. Wilhelmina, et al, 02cv04911 Charity Distribution.
See page 213 for disclosure information.
Identification
Copyright
© 2016 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
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- Autonomic Nervous System Function in Patients With Takotsubo SyndromeAmerican Journal of CardiologyVol. 117Issue 7
- PreviewI read the report by Norcliffe-Kaufmann et al1 published in the January 15, 2015, issue of the Journal, about the autonomic nervous system (ANS) evaluation of 10 women with a history of confirmed Takotsubo syndrome (TTS), which they had suffered more than a mean of 3 years previously, with comparisons with 10 normal control subjects. The authors' ANS comprehensive assessment at rest and during physical, emotional, and cognitive stimulation was further amplified with measurements of brachial artery flow-mediated vasodilation, ambulatory blood pressure monitoring, and plasma catecholamine levels.
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- Brain–Heart Disconnection: A Protective Effect of Diabetes Mellitus in Takotsubo CardiomyopathyAmerican Journal of CardiologyVol. 117Issue 11
- PreviewThe work by Norcliffe-Kaufmann et al1 published in a recent issue of the American Journal of Cardiology is commendable. The investigators noted excessive pressor responses to cognitive stress, emotional arousal, and hemodynamic stimuli in patients with takotsubo cardiomyopathy (TC), whereas indexes of parasympathetic modulation of heart rate induced by respiration and cardiovagal baroreflex gain were significantly blunted in TC women compared with controls.1
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