Attempted suicide as a trigger of Takotsubo syndrome: a minireview of available case reports

The Association of Mental Health Disorders with Takotsubo Syndrome (Broken Heart Syndrome) Among Older Women

Background: The prevalence of mental health disorders (MHD) and takotsubo syndrome (TS), also known as broken heart syndrome, is increasing and more common in older women. Mortality among persons with TS is comparable to that of persons with myocardial infarction. Although TS is poorly understood, it is thought to be precipitated by psychological stress. We examined the relationship between MHD and TS among elderly American women. Materials and Methods: Data consisted of 10.9 million hospitalizations among women aged ≥60 years recorded in the National Inpatient Sample from 2007 to 2015. International Classification of Diseases, Ninth Revision, codes were used to define TS, MHD, and other chronic conditions. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between MHD and TS. Results: The mean age of patients was 76 years, with 38% of them diagnosed with MHD. Over the 9-year period, the prevalence of TS hospitalizations increased by almost fourfold from 37.1/100,000 to 154.7/100,000, with a higher prevalence among patients with MHD. In multivariable adjusted models, MHD was associated with elevated odds of TS (OR = 1.25; 95% CI: 1.18-1.32), with the odds increasing with the frequency of MHD diagnosis. Among patients with one MHD, the odds of TS were significantly higher among those diagnosed with adjustment, anxiety, and mood disorders but lower among those with suicide ideations and personality disorders. Conclusions: The presence of MHD was associated with elevated odds of TS. Understanding underlying mechanisms linking MHD with TS will enhance MHD management.

Psychiatric conditions in patients presenting with Takotsubo syndrome: A systematic review and synthesis of case studies

OBJECTIVES

The purpose of this systematic review was to describe psychiatric presentations observed among Takotsubo syndrome (TS) patients, how psychiatric conditions and associated treatments impact TS events, and how psychiatric conditions are managed alongside TS medical treatment and follow-up.

METHODS

We searched MEDLINE, Cochrane Database of Systematic Reviews, Embase, PsycInfo, CINAHL, and Web of Science between 1990 and 2019 for case reports of TS with comorbid psychiatric conditions, behaviors, or substance use.

RESULTS

Of 2403 records, we included 243 records comprising 252 total cases. Common psychiatric conditions included depression (n = 98; 39%), anxiety (n = 44, 17%), alcohol use (n = 35, 14%), suicidality (n = 30, 12%), and severe mental illness (n = 25, 10%). Psychiatric conditions were frequently associated with triggering TS events (61%). Less than one-third of cases reported providing psychiatric care during hospitalization (n = 80, 32%). Only 33 cases (13%) described psychiatric functioning at follow-up. All case studies were assessed to be of low quality; patterns of reporting bias were observed.

CONCLUSIONS

Despite heterogeneous psychiatric presentations among TS patients, psychiatric treatment was rarely incorporated into the medical care or addressed at follow-up. This gap may be better attended to by integrating psychiatrists and psychologists into the multidisciplinary treatment team.

PROSPERO REGISTRATION NUMBER

CRD42019119998.

Traumatic Events, Personality and Psychopathology in Takotsubo Syndrome: A Systematic Review

OBJECTIVE

Takotsubo syndrome (TTS) is a transient heart disease that has been historically related to the occurrence of psychological (emotional) factors ("broken heart" syndrome). We aimed to conduct a systematic review analyzing the role of psychological factors in TTS.

METHODS

All studies on TTS and psychological factors from January 1991 through April 2019 were scrutinized according to the Cochrane Collaboration and the PRISMA statements. Selected studies were additionally evaluated for the Risk of Bias according to the Newcastle-Ottawa Scale (NOS).

RESULTS

Fifteen case-control studies (by Mayo Clinic criteria) were finally selected. Most studies analyzed stressful life-events or trauma, although with conflicting findings, while a likely role of long-lasting psychological distress seemed to be a homogenous result. Among life-time psychopathology, only anxiety appeared to have a significant role. Some studies outlined a likely role of personality, but findings are conflicting.

CONCLUSION

Our findings do not lead to any definitive assumption on the specific role of psychological factors in TTS, also for scant strong methodology of the most part of the studies. More studies with stronger research methodology are needed to better characterize psychological elements in TTS.

Identification of gene ontology and pathways implicated in suicide behavior: Systematic review and enrichment analysis of GWAS studies

Multiple large-scale studies such as genome-wide association studies (GWAS) have been performed to identify genetic contributors to suicidal behaviors (SB). We aimed to summarize and analyze the information obtained in SB GWAS, to explore the biological process gene ontology (GO) of genes associated with SB from GWAS, and to determine the possible implications of the genes associated with SB in Kyoto encyclopedias of genes and genomes (KEGG) biological pathways. The articles included in the analysis were obtained from PubMed and Scopus databases. Enrichment analyses were performed in Enrichr to evaluate the KEGG pathways and GO of the genes associated with SB of GWAS. The findings of biological process GO analysis showed 924 GO involved in genes related with SB; of those, the regulation of glucose import in response to insulin stimulus, regulation of protein localization to plasma membrane, positive regulation of endopeptidase activity, heterotypic cell-cell adhesion, regulation of cardiac muscle cell contraction, positive regulation of protein localization to plasma membrane, and positive regulation of protein localization to cell periphery biological process GO showed significant statistical association. Furthermore, we obtained 130 KEGG pathways involved in genes related with SB, which Aldosterone synthesis and secretion, Rap1 signaling pathway and arrhythmogenic right ventricular cardiomyopathy pathways showed a significant statistical association. These findings give a better perspective of the biological participation of genes associated with SB, which will be important to perform adequate strategies to prevent and treat SB.

Takotsubo syndrome and dialysis: an uncommon association?

This review was performed to investigate the association between treatment with dialysis and Takotsubo syndrome in patients with end-stage renal disease. We systematically explored the PubMed database using the search terms "Takotsubo cardiomyopathy" and/or "stress-induced cardiomyopathy" and/or "Takotsubo syndrome" in combination with "dialysis" and "uremia." Of 3630 articles found, 8 articles reporting 10 cases were selected for analysis. Most patients were women, and their age ranged from 51 to 84 years. Diabetes mellitus and hypertension were diagnosed in 40% of patients, and glomerular disease was diagnosed in 30%. One only patient was treated with peritoneal dialysis; all others were treated with hemodialysis. The outcome was unfavorable in only one patient. An association between Takotsubo syndrome and dialysis is uncommon, but not negligible, and comorbidities play a major role in determining the clinical outcome.