Detection of neurobiological stress associated with risk for takotsubo cardiomyopathy
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Risk for development of takotsubo cardiomyopathy may be associated with level of amygdala activity as measured by PET or CT imaging, according to data published in the European Heart Journal.
“Activity in the amygdala, a brain center involved in the perception of and response to stressors, associates with heightened sympathetic nervous system and inflammatory output and risk of cardiovascular disease,” Azar Radfar, MD, nuclear cardiology fellow at Massachusetts General Hospital, and colleagues wrote. “We hypothesized that the amygdalar activity ratio is heightened among individuals who develop takotsubo syndrome, a heart failure syndrome often triggered by acute stress.”
For this retrospective study, researchers identified 104 adults (median age, 68 years; 72% women) using the Partners HealthCare System Research Patient Data Registry of the Massachusetts General Hospital and Brigham and Women’s Hospital who underwent fluorodeoxyglucose (FDG)-PET and/or CT imaging.
The cohort included 41 patients who subsequently developed takotsubo syndrome and 63 matched controls. Median follow-up after imaging was 2.5 years.
Researchers observed that patients who developed subsequent takotsubo syndrome had higher baseline amygdala activity compared with the control group (P = .038).
After adjustment for risk factors, amygdala activity was independently associated with risk for subsequent takotsubo syndrome (HR = 1.643; 95% CI, 1.189-2.27; P = .003).
“Although a link between the brain and heart has long been proposed as a critical factor in the development of takotsubo syndrome, the underlying mechanisms have not been well described,” Ahmed Tawakol, MD, director of nuclear cardiology and co-director of the cardiovascular imaging research center at Massachusetts General Hospital, told Healio. “The current study points to a proximal, and potentially key, component of that mechanism. Specifically, heightened activity in stress-related centers of the brain was found to exist prior to the development of the syndrome, and thus may act as a risk factor for the disease by increasing the likelihood that exposure to a substantial stressor would result in takotsubo syndrome.”
Moreover, individuals with higher amygdala activity developed takotsubo syndrome approximately 2 years earlier compared with those with lower amygdala activity (beta = 2.72; 95% CI, 5.12 to 0.32; P = .028), even after adjustment for CVD risk factors (P = .029) and HF risk factors (P = .043).
“These findings add to the body of literature that highlight the adverse effect of stress on the CV system,” Tawakol told Healio. “Findings such as these underscore the need for more study into the impact of stress reduction, or drug interventions targeting these brain regions, on heart health. In the meantime, when encountering a patient with high chronic stress, clinicians could reasonably consider the possibility that alleviation of stress might result in benefits to the cardiovascular system.”
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