Ouaddi Sara, Liu Christopher, Keirns Natalie, Dunsiger Shira, Breault Christopher, Song Christopher, Lou Junyang, Gathright Emily, Tripolone Janice, Abbott J Dawn, Salmoirago-Blotcher Elena
Biopsychosoc Sci Med. 2025 Aug 29. doi: 10.1097/PSY.0000000000001432.
Takotsubo Syndrome (TS), is an acute, transient heart failure primarily affecting older women. Excessive sympathetic stimulation from emotional or physical stressors is assumed to trigger TS through a toxic surge in plasma catecholamines. Case reports have signaled the onset of TS following treatment with serotonin and catecholamine reuptake inhibitors. This case-control study investigated whether the use of these medications could be associated with TS onset.
Incident TS cases (n=98) and myocardial infarction (MI; n=32) controls were recruited among women admitted to five emergency departments in New England. Information on psychotropic medications was abstracted from medical records. Logistic regression models were used to examine associations between pre-admission psychotropic medication use and TS onset.
Demographics were similar between groups (98 TS, 32 MI) except for race (92% White in TS vs. 78% in MI). TS women more frequently had a history of any psychiatric disorder (50% vs. 28%, P=0.002); mood disorders, 32% vs. 22% (P=0.41); anxiety disorders, 32% vs. 9% (P =0.024). Logistic regression models adjusting for psychiatric comorbidity showed that women with TS were more likely to have taken any psychotropic medication (OR=4.10; CI 1.42, 5.0); or any catecholamine or serotonin reuptake inhibitor pre-admission (OR=3.39; CI: 1.17, 12.3). Analysis by medication type showed the latter association was driven by associations with SNRI use (11% vs. 0%; P=0.10).
These findings suggest that the use of catecholamine or serotonin reuptake inhibitors may increase the risk of TS. The use of such medications should be carefully considered in TS survivors.
应激性心肌病（TS）是一种主要影响老年女性的急性、短暂性心力衰竭。情绪或身体应激源产生的过度交感神经刺激被认为通过血浆儿茶酚胺的毒性激增引发TS。病例报告表明，使用5-羟色胺和儿茶酚胺再摄取抑制剂后会出现TS。本病例对照研究调查了使用这些药物是否可能与TS发病有关。
在新英格兰地区五家急诊科收治的女性中招募了新发TS病例（n = 98）和心肌梗死（MI；n = 32）对照。从医疗记录中提取有关精神药物的信息。采用逻辑回归模型来检验入院前使用精神药物与TS发病之间的关联。
除种族外（TS组92%为白人，MI组78%为白人），两组（98例TS，32例MI）的人口统计学特征相似。TS女性更常患有任何精神疾病（50%对28%，P = 0.002）；情绪障碍，32%对22%（P = 0.41）；焦虑症，32%对9%（P = 0.024）。针对精神疾病合并症进行调整的逻辑回归模型显示，TS女性更有可能服用过任何精神药物（比值比[OR]=4.10；置信区间[CI] 1.42，5.0）；或在入院前服用过任何儿茶酚胺或5-羟色胺再摄取抑制剂（OR = 3.39；CI：1.17，12.3）。按药物类型分析显示，后一种关联是由与5-羟色胺-去甲肾上腺素再摄取抑制剂（SNRI）使用的关联驱动的（11%对0%；P = 0.10）。
这些发现表明，使用儿茶酚胺或5-羟色胺再摄取抑制剂可能会增加TS的风险。在TS幸存者中应谨慎考虑使用此类药物。
