Chronic adrenocortical activity and onset of Takotsubo syndrome

AIMS: To study whether chronic physiological stress may play a role in the onset of Takotsubo syndrome (TS) and whether it is associated with worse psychological distress in patients recovering from a recent TS episode. METHODS AND RESULTS: We compared hair cortisol concentration (HCC), a validated biomarker of chronic stress, between a group of patients recently admitted with a new diagnosis of TS (Mayo criteria) and a cohort of clinically stable historical controls. HCC, demographics, perceived stress, depression, anxiety, post-traumatic stress disorder symptoms, and trigger history were assessed approximately 4 weeks after discharge. Descriptive statistics and linear regression models were used to assess associations. Participants (n = 59) had a mean age of 64.5 years and were mostly non-Hispanic White (94.9%) and female (96.6%). A large proportion of participants had a history of psychiatric disorders (62.7%), including anxiety disorders (40.7%) and mood disorders (39.0%). The HCC in the TS sample was twice as high as that of clinically stable controls (geometric mean: 7.3 pg/mg (SD 2.9) vs. 3.5 pg/mg (SD 3.7), P < 0.01). We found that patients with higher HCC did not report a history of triggers prior to TS onset or greater psychological distress post-discharge. CONCLUSION: Patients with a recent TS episode had significantly higher HCC compared with clinically stable controls, suggesting that chronic physiological stress may play a role in the onset of TS. These preliminary findings support further investigation into the effects of stress-reduction approaches for the prevention of recurrent TS and related morbidity. REGISTRATION: ClinicalTrials.gov NCT04325321.