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Stress-Induced Hyperviscosity in the Pathophysiology of Takotsubo Cardiomyopathy

https://doi.org/10.1016/j.amjcard.2013.01.304Get rights and content

Takotsubo cardiomyopathy (TC) is characterized by transient hypokinesis of the left ventricular apex or midventricular segments with coronary arteries without significant stenosis. It is often associated with emotional or physical stress; however, its pathophysiology is still unclear. In the present study, we analyzed the alterations in blood viscosity and markers of endothelial damage induced by sympathetic stimulation in patients with previous TC. Seventeen women (mean age 71 years) with previous TC, included and investigated in the TC Tuscany Registry, were compared to a control group of 8 age- and risk factor-matched women with chest pain and coronary arteries free of stenosis. All subjects underwent the cold pressor test (CPT). Before and after the CPT, the hemorheologic parameters (whole blood viscosity at 0.512 s−1 and 94.5 s−1, plasma viscosity, erythrocyte deformability index, and erythrocyte aggregation), catecholamines, plasminogen activator inhibitor-1 (PAI-1), and von Willebrand factor levels were assessed. The patients with TC had significantly greater baseline PAI-1 levels (p <0.01) and lower erythrocyte deformability index values (p <0.01). After CPT, both the patients with TC and the controls had a significant increase in several hemorheologic parameters, catecholamines, and von Willebrand factor levels and a decrease in erythrocyte deformability index. However, the PAI-1 levels were significantly increased only in the patients with TC. Compared to the controls, the patients with TC had significantly greater values of whole blood viscosity at 94.5 s−1 (p <0.05), PAI-1 (p <0.01), von Willebrand factor (p <0.05) and lower erythrocyte deformability index values (p <0.01) after CPT. In conclusion, the results of the present study suggest that in patients with TC, the alterations in erythrocyte membranes and endothelial integrity induced by catecholaminergic storm could determine microvascular hypoperfusion, possibly favoring the occurrence of left ventricular ballooning.

Section snippets

Methods

In the Department of Heart and Vessels, from January to December 2007, 17 patients (all women, aged 71 ± 12 years) with previous TC diagnosed according to the Mayo Clinic criteria, as previously reported,7 were included in the Tuscany Registry of TC and previously investigated.7 A stressful situation resulted in precipitating the event in 13 patients with TC, whose symptoms had been chest pain or dyspnea. ST-segment elevation in V1 to V3 leads followed by T-wave inversion was the most frequent

Results

No significant differences in the cardiovascular risk factors or baseline blood count parameters and fibrinogen values were found between the patients with TC and the controls. The hemorheologic and endothelial variables in the patients and controls before and after the CPT are listed in Table 1 and shown in Figure 1, Figure 2, Figure 3. At baseline, a significantly lower erythrocyte deformability index (p <0.05) and greater PAI-1 levels (p <0.05) were found in patients with previous TC

Discussion

This is the first study to analyze alterations in the hemorheologic and endothelial parameters induced by acute sympathetic stimulation in patients with previous TC.

The main finding of the present study was that patients with TC have, at baseline, an altered erythrocyte deformability and greater PAI-1 plasma levels compared to the controls. Moreover, these patients had, after sympathetic stimulation, an exaggerated response in terms of alterations in several hemorheologic parameters and in

Disclosures

The authors have no conflicts of interest to disclose.

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