Mariano Enrica G, Marconi Michela, Pozzi Gino, Locorotondo Gabriella, Cecchini Edoardo, Malci Fabiana, Sposini Ghezzi Sara, Polese Daniela, Galiuto Leonarda
Division of Cardiology, Department of Medical Sciences, Tor Vergata Polyclinic Foundation, Rome, Italy -
IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy.
Panminerva Med. 2024 Dec;66(4):380-391. doi: 10.23736/S0031-0808.24.05187-5. Epub 2024 Dec 6.
Takotsubo syndrome (TTS) is an acute reversible heart dysfunction affecting mostly post-menopausal women, frequently precipitated by a significant stressful event, presenting as an acute coronary syndrome (ACS) in the absence of obstructive coronary artery disease. The pathogenesis is not fully understood, but a close relationship between individual's mind, brain, neuroendocrine system and the heart may be involved in a mind-heart axis. The purpose of this study was to compare the prevalence of psychopathological findings in TTS patients as compared to healthy subjects, patients affected by psychiatric diseases and patients affected by ACS.
This observational study enrolled 40 female subjects divided into 4 subgroups: TTS patients, healthy subjects, psychiatric patients and ACS patients, matched for age. Psychosocial factors and psychopathological dimensions have been evaluated. Patients who signed informed consent were interviewed by the administration of a complex psychometric battery, including Mini International Neuropsychiatric Interview, Hamilton Rating Scale for Depression, State Trait Anxiety Inventory, Form Y.
Comparing the groups, the TTS group showed a statistically significant difference vs. ACS group concerning psychological violence subscale (P=0.049) of the Childhood Trauma Questionnaire, while significant statistical difference emerged in TTS group vs. healthy subjects control group, regarding cyclothymia subscale (P=0.008). Statistically significant differences were documented in TTS group vs. psychiatric cohort in cyclothymia subscale (P=0.012). Moreover, comparison between TTS and ACS group, revealed a statistically significant difference in the sub-scale of self-confidence and management of negative emotions (P=0.0028). One of the most significant features was the evidence of statistically significant differences in TTS vs. ACS group, concerning total and average value of anxiety (P=0.014 and P=0.031 respectively) and in the comparison of TTS group vs. healthy subjects (P=0.005 for the total anxiety value and P=0.021 for the average value). Finally, both depression and mania were statistically significant raised in the TTS group compared to the healthy subjects' group (P=0.00 and P=0.013, respectively).
Psychosocial and psychopathological dimensions of TTS patients have been explored and analyzed in a cohort of TTS patients vs. ACS, healthy subjects and psychiatric patients, showing statistically significant differences among the various groups. Psychopathological symptoms were more frequent in TTS patients, suggesting an evident involvement of mind-heart axis in this disease. Future studies are needed to investigate the cause-effect relationship between psychopathological features and the occurrence of TTS.
应激性心肌病（TTS）是一种急性可逆性心脏功能障碍，主要影响绝经后女性，常由重大应激事件诱发，在无阻塞性冠状动脉疾病的情况下表现为急性冠状动脉综合征（ACS）。其发病机制尚未完全明确，但个体的心理、大脑、神经内分泌系统与心脏之间的密切关系可能涉及心脑轴。本研究的目的是比较TTS患者与健康受试者、精神疾病患者和ACS患者的精神病理学发现的患病率。
本观察性研究纳入40名女性受试者，分为4个亚组：TTS患者、健康受试者、精神疾病患者和ACS患者，年龄匹配。评估了社会心理因素和精神病理学维度。签署知情同意书的患者接受了一套综合心理测量量表的访谈，包括迷你国际神经精神病学访谈、汉密尔顿抑郁量表、状态特质焦虑量表Y型。
比较各亚组，TTS组与ACS组在儿童创伤问卷的心理暴力子量表方面存在统计学显著差异（P = 0.049），而TTS组与健康受试者对照组在环性心境障碍子量表方面出现显著统计学差异（P = 0.008）。TTS组与精神疾病队列在环性心境障碍子量表方面有统计学显著差异（P = 0.012）。此外，TTS组与ACS组比较，在自信和负面情绪管理子量表方面存在统计学显著差异（P = 0.0028）。最显著的特征之一是TTS组与ACS组在焦虑总分和平均值方面存在统计学显著差异（分别为P = 0.014和P = 0.031），以及TTS组与健康受试者比较（焦虑总值P = 0.005，平均值P = 0.021）。最后，与健康受试者组相比，TTS组的抑郁和躁狂均有统计学显著升高（分别为P = 0.00和P = 0.013）。
在一组TTS患者与ACS患者、健康受试者和精神疾病患者中探索并分析了TTS患者的社会心理和精神病理学维度，各亚组间存在统计学显著差异。TTS患者的精神病理学症状更为常见，表明心脑轴在该疾病中明显受累。未来需要进一步研究精神病理学特征与TTS发生之间的因果关系。
