RT Journal Article
SR Electronic
T1 BS7 Neurohumoral responses in Takotsubo syndrome
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP A147
OP A147
DO 10.1136/heartjnl-2022-BCS.187
VO 108
IS Suppl 1
A1 Khan, Hilal
A1 Rudd, Amelia
A1 Gamble, David
A1 Mezincescu, Alice
A1 Cheyne, Lesley
A1 Horgan, Graham
A1 Dhaun, Neeraj
A1 Newby, David E
A1 Dawson, Dana K
YR 2022
UL http://heart.bmj.com/content/108/Suppl_1/A147.abstract
AB Background We investigate if renin-angiotensin and endothelin-1 response pathways follow the same pattern of recovery as left ventricular ejection fraction in patients with takotsubo syndrome.Methods Ninety takotsubo syndrome patients [n=30 in each of ‘acute’,‘convalescent’ (3–5 months) and ‘recovered’ (> 1 year) groups] who were on minimal or no medication and were free of any significant cardiac/metabolic co-morbidities, and 30 healthy controls were studied. Serum concentrations of renin, angiotensin converting enzyme, angiotensin II, big endothelin-1, endothelin-1 were measured using commercially available ELISA, and BNP was measured using an immunoassay.Results Left ventricular ejection fraction was 38 ± 1.6 % in acute, 63 ± 2.0 % in convalescent and 64 ± 2.6 % in recovered takotsubo syndrome patients. As shown in the Figure, serum renin concentrations are persistently elevated after a takotsubo episode (p=0.03 vs controls). Angiotensin converting enzyme levels are significantly depressed during the acute phase compared to convalescent (p=0.004), recovered takotsubo (p=0.02) or controls (p=0.03). Angiotensin II is increased in takotsubo patients (p<0.001 vs controls) remaining persistently elevated long-term in the recovered group (p=0.03 vs controls). B-type natriuretic peptide concentrations remain elevated after a takotsubo episode compared to controls (p=0.003). Big endothelin-1 levels are unchanged, but endothelin-1 is significantly lower after takotsubo syndrome compared to controls (p=0.03).Abstract BS7 Figure 1 Conclusions Despite ‘normalisation’ of the left ventricular ejection fraction, there is long-term maladaptive activation of renin-angiotensin system in takotsubo syndrome patients. This suggests therapy aimed at modulating this pathway may be beneficial in the long-term.