Heart Rate Variability Alterations in Takotsubo Syndrome and Related Association with Psychological Factors: a Systematic Review and Meta-analysis

Overview

Journal Sci Rep

Specialty Science

Date 2023 Nov 25

PMID 38007581

Authors

Gianluca Cruciani

Marco Cavicchioli

Gaetano Tanzilli

Annalisa Tanzilli

Vittorio Lingiardi

Federica Galli

Affiliations

Soon will be listed here.

Abstract

Psychological factors may have a precipitant role in takotsubo syndrome (TS). Aberrant Heart Rate Variability (HRV) has been reported in TS, suggesting inflexibility of the autonomous nervous system. Nevertheless, results on HRV alterations and their link with psychological factors in TS are conflicting. This work aimed to systematically explore whether TS may be associated with HRV alterations and their association with specific psychological profiles in TS patients. A literature search was conducted across databases (Pubmed, Scopus, PsycInfo, Web of Science) and empirical studies including TS patients which were evaluated in one or more HRV indices were retrieved. HRV and psychological outcomes were extracted. 10 empirical studies with 194 TS patients were included. Results showed significant alteration of HRV in TS patients, with indices compared to controls, and a progressive increase over time. Nevertheless, retrieved data presented mixed results, as also shown by a large heterogeneity in the meta-analytic findings. 2 studies found significant relationships between HRV alterations and trait-rather than state-psychological outcomes (i.e., coping strategies and emotional arousal), pointing to the need to explore the role of psychological vulnerabilities, rather than single traumatic stressors, in the association between HRV and TS.

References

Lacey C, Mulder R, Bridgman P, Kimber B, Zarifeh J, Kennedy M . Broken heart syndrome -- is it a psychosomatic disorder?. J Psychosom Res. 2014; 77(2):158-60. DOI: 10.1016/j.jpsychores.2014.05.003. View

Ghadri J, Kato K, Cammann V, Gili S, Jurisic S, Di Vece D . Long-Term Prognosis of Patients With Takotsubo Syndrome. J Am Coll Cardiol. 2018; 72(8):874-882. DOI: 10.1016/j.jacc.2018.06.016. View

Grimes D, Schulz K . An overview of clinical research: the lay of the land. Lancet. 2002; 359(9300):57-61. DOI: 10.1016/S0140-6736(02)07283-5. View

Park G, Thayer J . From the heart to the mind: cardiac vagal tone modulates top-down and bottom-up visual perception and attention to emotional stimuli. Front Psychol. 2014; 5:278. PMC: 4013470. DOI: 10.3389/fpsyg.2014.00278. View

Thayer J, Hansen A, Saus-Rose E, Johnsen B . Heart rate variability, prefrontal neural function, and cognitive performance: the neurovisceral integration perspective on self-regulation, adaptation, and health. Ann Behav Med. 2009; 37(2):141-53. DOI: 10.1007/s12160-009-9101-z. View

Hillebrand S, Gast K, de Mutsert R, Swenne C, Jukema J, Middeldorp S . Heart rate variability and first cardiovascular event in populations without known cardiovascular disease: meta-analysis and dose-response meta-regression. Europace. 2013; 15(5):742-9. DOI: 10.1093/europace/eus341. View

Ortak J, Khattab K, Barantke M, Wiegand U, Bansch D, Ince H . Evolution of cardiac autonomic nervous activity indices in patients presenting with transient left ventricular apical ballooning. Pacing Clin Electrophysiol. 2009; 32 Suppl 1:S21-5. DOI: 10.1111/j.1540-8159.2008.02221.x. View

Goh A, Wong S, Zaroff J, Shafaee N, Lundstrom R . Comparing Anxiety and Depression in Patients With Takotsubo Stress Cardiomyopathy to Those With Acute Coronary Syndrome. J Cardiopulm Rehabil Prev. 2015; 36(2):106-11. DOI: 10.1097/HCR.0000000000000152. View

Kujime S, Hara H, Enomoto Y, Nakamura K, Yoshitama T, Noro M . Analysis of Heart Rate Variability in a Patient with Takotsubo Cardiomyopathy Syndrome on the Actual Onset Day. Int Heart J. 2019; 60(6):1444-1447. DOI: 10.1536/ihj.19-092. View

10.

Laborde S, Mosley E, Thayer J . Heart Rate Variability and Cardiac Vagal Tone in Psychophysiological Research - Recommendations for Experiment Planning, Data Analysis, and Data Reporting. Front Psychol. 2017; 8:213. PMC: 5316555. DOI: 10.3389/fpsyg.2017.00213. View

11.

Brinza C, Floria M, Covic A, Burlacu A . Measuring Heart Rate Variability in Patients Admitted with ST-Elevation Myocardial Infarction for the Prediction of Subsequent Cardiovascular Events: A Systematic Review. Medicina (Kaunas). 2021; 57(10). PMC: 8540987. DOI: 10.3390/medicina57101021. View

12.

Grossman P, Taylor E . Toward understanding respiratory sinus arrhythmia: relations to cardiac vagal tone, evolution and biobehavioral functions. Biol Psychol. 2006; 74(2):263-85. DOI: 10.1016/j.biopsycho.2005.11.014. View

13.

Salmoirago-Blotcher E, Rosman L, Wittstein I, Dunsiger S, Swales H, Aurigemma G . Psychiatric history, post-discharge distress, and personality characteristics among incident female cases of takotsubo cardiomyopathy: A case-control study. Heart Lung. 2016; 45(6):503-509. DOI: 10.1016/j.hrtlng.2016.07.008. View

14.

Bonnemeier H, Demming T, Weidtmann B, Ortak J, Burgdorf C, Reppel M . Differential heart rate dynamics in transient left ventricular apical and midventricular ballooning. Heart Rhythm. 2010; 7(12):1825-32. DOI: 10.1016/j.hrthm.2010.08.025. View

15.

Sedgwick P . Case-control studies: advantages and disadvantages. BMJ. 2019; 348:f7707. DOI: 10.1136/bmj.f7707. View

16.

Ghadri J, Wittstein I, Prasad A, Sharkey S, Dote K, Akashi Y . International Expert Consensus Document on Takotsubo Syndrome (Part I): Clinical Characteristics, Diagnostic Criteria, and Pathophysiology. Eur Heart J. 2018; 39(22):2032-2046. PMC: 5991216. DOI: 10.1093/eurheartj/ehy076. View

17.

Norcliffe-Kaufmann L, Reynolds H . Afferent baroreflex failure and tako-tsubo cardiomyopathy. Clin Auton Res. 2011; 21(1):1-2. DOI: 10.1007/s10286-010-0113-3. View

18.

del Paso G, Langewitz W, Robles H, Perez N . A between-subjects comparison of respiratory sinus arrhythmia and baroreceptor cardiac reflex sensitivity as non-invasive measures of tonic parasympathetic cardiac control. Int J Psychophysiol. 1996; 22(3):163-71. DOI: 10.1016/0167-8760(96)00020-7. View

19.

Galli F, Bursi F, Carugo S . Traumatic Events, Personality and Psychopathology in Takotsubo Syndrome: A Systematic Review. Front Psychol. 2020; 10:2742. PMC: 6914859. DOI: 10.3389/fpsyg.2019.02742. View

20.

Collste O, Tornvall P, Sundin O, Alam M, Frick M . No myocardial vulnerability to mental stress in Takotsubo stress cardiomyopathy. PLoS One. 2014; 9(4):e93697. PMC: 3973547. DOI: 10.1371/journal.pone.0093697. View