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Cortisol awakening and stress response, personality and psychiatric profiles in patients with takotsubo cardiomyopathy
  1. Sabrina Kastaun1,2,
  2. Niko P Schwarz1,
  3. Martin Juenemann1,3,
  4. Mesut Yeniguen1,3,
  5. Holger M Nef4,
  6. Helge Moellmann5,
  7. Christian W Hamm4,5,
  8. Gebhard Sammer6,
  9. Juergen Hennig7,
  10. Georg Bachmann1,8,
  11. Tibo Gerriets1,3
  1. 1Department of Neurology, Heart & Brain Research Group, University Hospital Giessen and Marburg, Giessen, Germany
  2. 2Department of Heart Surgery, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
  3. 3Department of Neurology, Buergerhospital Friedberg, Friedberg, Germany
  4. 4Department of Cardiology, University Hospital Giessen and Marburg, Giessen, Germany
  5. 5Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
  6. 6Department of Psychiatry, University Hospital Giessen and Marburg, Giessen, Germany
  7. 7Department of Psychology, Personality Psychology and Individual Differences, Justus Liebig University, Giessen, Germany
  8. 8Department of Radiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
  1. Correspondence to Professor Tibo Gerriets, Department of Neurology, Heart & Brain Research Group, University Hospital Giessen and Marburg, Klinikstraße 33, Giessen 35392, Germany; tibo.gerriets{at}neuro.med.uni-giessen.de

Abstract

Objective Alterations in cortisol awakening and stress responses (CAR, CSR) are sensitive markers for the basal activity and responsiveness of the hypothalamus–pituitary–adrenal axis (HPAA) in psychopathological conditions. We investigated whether patients with takotsubo cardiomyopathy (TTC) differ in these markers when compared with non-ST-segment elevation myocardial infarction (NSTEMI) patients and healthy controls.

Methods 19 female TTC patients were compared with 20 female NSTEMI patients and with 20 healthy women, matched by age and index event date. Salivary sampling indicated cortisol release, questionnaires assessed personality, life events, chronic stress and psychiatric symptoms.

Results The groups did not differ relevantly in their basal HPAA activity, psychiatric or personality profiles. Despite increased heart rates in response to stress (median difference (MDdiff)=3.5, p=0.002) and higher nervousness scores (MDdiff=−3.0, p=0.024), TTC patients revealed a blunted CSR with a medium effect compared to the controls (MDdiff=−3.2 nmol/L, p=0.022, r=0.36); even when controlled for prestress cortisol differences (p=0.044, r=0.33). In comparison with NSTEMI patients, no significant differences in CSR (MDdiff=−1.9 nmol/L, p=0.127, r=0.25) or nervousness (MDdiff=2.0, p=0.107) can be observed. Stressful life events, for example, traumatic experiences, occurred more often in TTC (42%) than in NSTEMI patients and controls (both 10%, p=0.031).

Conclusions In this small exploratory trial, a trend for a blunted CSR and high incidences of stressful life events were observed in TTC patients. If these results can be confirmed in larger studies, chronic stress and the inhibitory influence of cortisol on catecholamine release might be significant for the pathogenesis of TTC.

Keywords
  • cortisol stress response
  • personality
  • psychiatric disorders

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