Myocardial dysfunction in Takotsubo syndrome: More than meets the eye?

Role of Positive Emotions in Takotsubo Cardiomyopathy

Takotsubo Cardiomyopathy, also known as "broken heart syndrome," is a transient cardiac condition characterized by sudden left ventricular dysfunction, often triggered by emotional stress or significant life events. While research has predominantly focused on the impact of negative emotions and emotional stressors, there is a growing interest in understanding the role of positive emotions in this unique cardiac syndrome. This narrative review explores the emerging research on positive emotions and Takotsubo Cardiomyopathy. It provides an overview of studies investigating the relationship between positive emotions and the condition, highlighting key findings and observations. Positive emotions, such as joy, happiness, gratitude, and optimism, have been associated with improved emotional well-being, better-coping mechanisms, and potential cardiovascular protection. Some studies suggest that individuals experiencing higher levels of positive emotions may have a reduced risk of developing Takotsubo Cardiomyopathy. However, the research in this area is still limited, with small sample sizes and challenges in quantifying positive emotions. Additionally, the interplay between positive and negative emotions requires further exploration to fully understand their impact on cardiovascular health. Despite these limitations, harnessing positive emotions in cardiac care holds promise for enhancing patient outcomes and emotional well-being. Integrating positive psychology into clinical practice and cardiac rehabilitation may lead to more holistic and patient-centered approaches to cardiovascular care. Further longitudinal studies, interventional trials, and mechanistic investigations are needed to strengthen the evidence base and identify potential therapeutic perspectives. As research progresses, addressing these gaps will provide valuable insights into the complex relationship between emotions and cardiovascular health, benefiting patients affected by Takotsubo Cardiomyopathy and other cardiovascular conditions.

Incremental prognostic value of global longitudinal strain to the coronary microvascular resistances in Takotsubo patients

BACKGROUND

Global longitudinal strain (GLS) allows an accurate assessment of left ventricular function with prognostic value. We aimed to evaluate whether the assessment of GLS in the acute phase of Takotsubo syndrome (TTS) provides incremental prognostic value to the degree of impaired microvascular resistance (MR) in TTS patients at 1-year follow-up.

METHODS

We recruited patients admitted for TTS who underwent cardiac angiography and echocardiography from January 2017 to June 2020. Left anterior descending coronary artery non-hyperaemic angiography-derived index of microcirculatory resistance (LAD NH-IMRangio) was calculated. NT-proBNP, high-sensitive cardiac troponin T (hs-cTnT), left ventricular ejection fraction (LVEF) and GLS were measured at admission. Major adverse cardiac events (MACE) were defined as the composite of cardiovascular death, repeat hospitalizations for heart failure (HF) and acute myocardial infarctions.

RESULTS

67 patients had both GLS and NH-IMRangio available and were included in the study. Median age was 75.2 years and 88% were women. Rate of MACE at 1-year was 13.4%. Kaplan-Meier curves showed higher rates of MACE at 1-year in patients with both higher LAD NH-IMRangio and GLS values compared with those with higher LAD NH-IMRangio and lower GLS values (33.3% vs. 11.1%; p = 0.049). NT-proBNP levels at admission and the recovery of LVEF were correlated with GLS values while MR and hs-cTnT were not.

CONCLUSION

GLS provides incremental prognostic value to the degree of impaired MR in TTS patients. The combination of a poorer GLS with a higher degree of impaired MR was associated with a higher rate of MACE in these patients.

A preliminary identification of PIN1 SNP linkage in patients with coronary heart disease from Handan, China

Our aim was to perform an initial assessment of the polymorphic patterns of the PIN1 gene in patients with coronary heart disease (CHD). The PIN1-encoded protein (Pin1) suppresses eNOS-NO signaling and may impair cardiovascular function. Blood collection, DNA extraction, PCR amplification and gene sequencing were performed for thirty CHD participants living in central China, focusing on nine single nucleotide polymorphisms (SNPs). Their genetic linkages were revealed and their allele frequencies were compared with SNP data from the NCBI. Three major linkage patterns were identified: [1.rs2287839-5.rs2233682], [3.rs2233679-4.rs1077220-8.rs2287838] and [6.rs889162-7.rs2010457], suggesting correlated involvement in CHD and possible simultaneous genetic origin in ancient times. The frequencies of six SNPs are consistent with the NCBI data, while the frequencies of three SNPs (2.rs2233678, 4.rs1077220 and 9.rs4804461) are not consistent with the NCBI. Especially, the 3.rs2233679-4.rs1077220 linkage is different from other populations worldwide and may be an interesting genetic characteristic of Chinese CHD patients. Predictably, 1.rs2287839, 2.rs2233678, 3.rs2233679 and 5.rs2233682 may be strongly associated with CHD risk, although this requires future verification. The PIN1 SNP linkages lay a new genetic foundation for discovering novel molecular mechanisms of CHD and for exploring PIN1-based targeted treatment of CHD with nitric oxide regulatory therapies in clinical practice.