Background: Takotsubo Syndrome (TTS) is an acute form of heart failure that disproportionately impacts post-menopausal women. The brain-heart connection is considered a pathway for TTS pathophysiology leading to investigations of the role of psychological, psychosocial, and personality factors in TTS.
Objectives: We compare psychosocial characteristics among a subset of individuals with confirmed TTS and those who had symptoms adjudicated as non-TTS in our online Takotsubo registry (n = 104). We also evaluate differences in TTS clinical characteristics among those with and without symptoms of PTSD and depression.
Methods: The Smidt Heart Institute Takotsubo registry enrolls individuals with a history of TTS sourced through physician referrals, medical records review, peer- and self-referrals. Psychosocial characteristics were assessed using questionnaires validated in acute coronary syndrome populations. Hedge's g effect sizes were computed to compare differences in perceived stress, depression symptoms, and post-traumatic stress disorder (PTSD) symptoms relative to TTS status.
Results: Compared to participants confirmed to be non-TTS, those with adjudication-confirmed TTS had worse mean psychosocial scores (indicative of worse psychosocial characteristics). After adjusting for age at event, BMI, race, and smoking status, the Hedge's g effect size for depressive symptoms was moderate [0.60 (-0.03, 1.22)] while effect sizes for other psychosocial measures were minimal (Trait anxiety: [0.01 (-0.58, 0.60)], PTSD symptoms [0.13 (-0.46, 0.73)], perceived stress [0.06 (-0.53, 0.65)]. Effect sizes were relatively lower following adjustment, largely driven by participants' age at first event. Individuals with elevated PTSD symptoms were significantly younger at their first TTS event compared to those with minimal or no symptoms (54 ± 8 vs. 61 ± 10; p = 0.005). QTc was relatively longer among individuals with elevated PTSD symptoms (483 ± 40 msec vs. 465 ± 32 msec; p = 0.08) and elevated depressive symptoms (481 ± 33 msec vs. 464 ± 36 msec; p = 0.07), although the differences were not statistically significant.
Conclusions: Psychosocial characteristics including PTSD, depression, and stress are common among women with TTS, and age at the time of TTS event is a potentially important moderator of this relationship. We did not find Trait-anxiety or early childhood trauma to be associated with TTS in our cohort.
Keywords: Depression; PTSD; Psychosocial characteristics; Stress cardiomyopathy; Takotsubo syndrome.
Takotsubo syndrome (TTS) is a form of heart failure that is linked to emotional and physical stressors. It commonly affects women after menopause. Literature suggests that the brain and heart are connected in this illness, so we studied how stress, depression, and other psychological factors might play a role. This study compared people with TTS to those with similar symptoms who didn’t have TTS. We used surveys to measure stress, depression, Post-Traumatic Stress Disorder (PTSD), and other psychosocial characteristics when participants enrolled into the study. Clinical characteristics were determined from a retrospective review of participants’ medical records during their TTS event.We found that individuals with confirmed TTS had scores that were representative of higher levels of depression, PTSD, and perceived stress compared to the group without TTS. Younger people with TTS were more likely to have PTSD symptoms. On average, people with PTSD symptoms had their first TTS event at age 54, while others had it at age 61. Depression and PTSD seemed to have a more considerable effect on TTS than anxiety or early-life trauma. The study shows that feelings like stress, depression, and PTSD are common in people with TTS, and age might make a difference in how these feelings affect the heart. Our findings offer additional insight into psychosocial features and associated clinical characteristics in TTS.
© 2025. The Author(s).