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Stress in brain linked to 'broken heart' syndrome

Friday March 26th 2021

Increased brain activity in the brain, brought on by stressful events, could increase the risk of the rare “broken heart” syndrome.

A new US study published today (26 March 2021) in the European Heart Journal found that Takotsubo syndrome (TTS) can develop if there is greater activity in nerve cells in the amygdala region and that a heart-brain connection is likely to play a major role.

The researchers suggest drug treatments and stress-relieving techniques could help to reduce the risk of developing TTS, which occurs when there is a sudden temporary weakening of the heart muscles that causes the left ventricle of the heart to balloon out at the bottom while the neck remains narrow.

Study leader Dr Ahmed Tawakol, co-director of the Cardiovascular Imaging Research Center at Massachusetts General Hospital and Harvard Medical School, Boston, said: “The study suggests that the increased stress-associated neurobiological activity in the amygdala, which is present years before TTS occurs, may play an important role in its development and may predict the timing of the syndrome. It may prime an individual for a heightened acute stress response that culminates in TTS.

“We show that TTS happens not only because one encounters a rare, dreadfully disturbing event - such as the death of a spouse or child, as the classical examples have it. Rather, individuals with high stress-related brain activity appear to be primed to develop TTS and can develop the syndrome upon exposure to more common stressors, even a routine colonoscopy or a bone fracture.

“We also identified a significant relationship between stress-associated brain activity and bone marrow activity in these individuals. Together, the findings provide insights into a potential mechanism that may contribute to the ‘heart brain connection’."

In what is the first study to examine brain scans using F-fluorodeoxyglucose positron emission tomography/computed tomography (PET-CT) to assess brain activity before TTS develops, Dr Tawakol and colleagues analysed data on 104 people.

The patients, who were an average age of 68 and 72% women, had undergone scans at Massachusetts General Hospital between 2005 and 2019, and the researchers matched 41 people who went on to develop TTS between six months and five years after the scan with 63 who did not.

The interval between the scan, the onset of TTS, last follow-up or death was an average of 2.5 years for the 104 patients.

The researchers found that people who went on to develop TTS had higher stress-related amygdalar activity on initial scanning compared to those who did not develop the condition. They also found that the higher the amygdalar signal, the greater the risk of developing TTS.

Of the 41 patients who developed TTS, the average interval between the scan and TTS was 0.9 months, while in the control group of 63 patients, the average interval between the scan and last follow-up or death was 2.9 years.

Dr Tawakol said: “It was notable that among the 41 patients who developed TTS, the top 15% with the very highest amygdalar activity developed TTS within a year of imaging, while those with less elevated activity developed TTS several years later.

“These findings add to evidence of the adverse effect of stress-related biology on the cardiovascular system. Findings such as these underscore the need for more study into the impact of stress reduction or drug interventions targeting these brain regions on heart health.

“In the meantime, when encountering a patient with high chronic stress, clinicians could reasonably consider the possibility that alleviation of stress might result in benefits to the cardiovascular system."

Radfar A, Abohashem S, Osborne MT et al. Stress-associated neurobiological activity associates with the risk for and timing of subsequent Takotsubo syndrome. European Heart Journal 26 March 2021. doi:10.1093/eurheartj/ehab029

[abstract]

Tags: Brain & Neurology | Heart Health | North America

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