Davide Lazzeroni1, Matteo Bini2, Paolo Castiglioni3, Luca Moderato2, Chiara Ciraci'4, Umberto Camaiora4, Pietro Tito Ugolotti4, Lorenzo Brambilla4, Valerio Brambilla4, Matteo Castrichini4, Fabrizio Ugo5, Nicola Gaibazzi6, Paolo Coruzzi2. 1. Vascular and Cardio-thoracic Department, San Raffaele Scientific Institute, Vita-Salute University San Raffaele, Milan, Italy; Cardiovascular Prevention and Rehabilitation Unit, Don Carlo Gnocchi Foundation, Parma, Italy. Electronic address: davide.lazzeroni@gmail.com. 2. Department of Clinical and Experimental Medicine, University of Parma, Italy. 3. IRCCS Fondazione Don C. Gnocchi, Milan, Italy. 4. Cardiovascular Prevention and Rehabilitation Unit, Don Carlo Gnocchi Foundation, Parma, Italy. 5. Division of Cardiology, San Giovanni Bosco Hospital, Torino, Italy. 6. Department of Cardiology, Parma University Hospital, Parma, Italy.
Abstract
OBJECTIVES: Although it is well documented that an exaggerated sympathetic stimulation plays a role in the development of Takotsubo Syndrome (TS) during the acute phase, only few studies have focused on autonomic adaptations in stress-induced cardiomyopathy long after the acute phase. Aim of the study was to investigate whether an impairment of the autonomic function is still present long after a TS event. This was done by comparing the response to a maximal exercise test in TS patients after apparent recovery (>1-year after the acute event) with that obtained in healthy subjects and in post-myocardial infarction (post-MI) patients. METHODS: To assess heart rate recovery (HRR) and chronotropic response (CR), 24 TS patients, 25 healthy subjects and 22 post-MI patients underwent maximal exercise test, after at least 3 days of β-blockers wash-out. RESULTS: HRR in TS patients (19.2±9.7bpm) was lower than in healthy subjects (27.7±8.3, p=0.003), and similar to post-MI patients (19.3±8.4; p=0.99). A decreasing CR trend (p=0.06), higher in healthy subjects (72±13%) than in TS (65±22%) and post-MI (57±21%) patients, was also found. CONCLUSION: Compared to healthy subjects, TS patients showed a blunted parasympathetic reactivation after exercise, similar to that observed in post-MI patients, thereby suggesting that vagal control of heart rate after exercise is abnormal long after the acute presentation of TS.
OBJECTIVES: Although it is well documented that an exaggerated sympathetic stimulation plays a role in the development of Takotsubo Syndrome (TS) during the acute phase, only few studies have focused on autonomic adaptations in stress-induced cardiomyopathy long after the acute phase. Aim of the study was to investigate whether an impairment of the autonomic function is still present long after a TS event. This was done by comparing the response to a maximal exercise test in TS patients after apparent recovery (>1-year after the acute event) with that obtained in healthy subjects and in post-myocardial infarction (post-MI) patients. METHODS: To assess heart rate recovery (HRR) and chronotropic response (CR), 24 TS patients, 25 healthy subjects and 22 post-MI patients underwent maximal exercise test, after at least 3 days of β-blockers wash-out. RESULTS: HRR in TS patients (19.2±9.7bpm) was lower than in healthy subjects (27.7±8.3, p=0.003), and similar to post-MI patients (19.3±8.4; p=0.99). A decreasing CR trend (p=0.06), higher in healthy subjects (72±13%) than in TS (65±22%) and post-MI (57±21%) patients, was also found. CONCLUSION: Compared to healthy subjects, TS patients showed a blunted parasympathetic reactivation after exercise, similar to that observed in post-MI patients, thereby suggesting that vagal control of heart rate after exercise is abnormal long after the acute presentation of TS.
Authors: Athanassios Manginas; Angelos G Rigopoulos; Boris Bigalke; Stefanos Sakellaropoulos; Muhammad Ali; Sophie Mavrogeni; Michel Noutsias Journal: BMC Cardiovasc Disord Date: 2017-12-20 Impact factor: 2.298