Key result
In two patients with takotsubo syndrome, the male patient exhibited more severe cardiac injury with contraction band necrosis, lymphocytic infiltration, and altered mitochondrial metabolic gene expression compared to the female patient.
Why the study?
The onset mechanism of takotsubo syndrome remains unclear, and while females are overwhelmingly affected, males experience more cardiac complications.
Case Report (n=2)
No
Left ventricular biopsy and DNA microarray analysis suggest distinct pathophysiological mechanisms in takotsubo syndrome between sexes, with males showing more severe myocardial injury and mitochondrial metabolic alterations.
Hypothesis-generating for sex-specific takotsubo injury; prospective studies needed before clinical implications.
BACKGROUND: Takotsubo syndrome is a stress-induced disease that makes up 2-3% of acute coronary syndrome cases. However, its onset mechanism remains unclear. Although females are overwhelmingly affected, males end up having more cardiac complications. CASE PRESENTATION: We examined the differences in stress responses in the myocardium between sexes in patients with takotsubo syndrome. We biopsied samples from an over 70-year-old Japanese male and an over 80-year-old Japanese female. Tissues from the left ventricle apex in the acute phase and the apical ballooning-type were examined using histopathology and deoxyribonucleic acid (DNA) microarray analysis. Our data showed that left ventricular ejection fractions were 38% and 56%, and peak creatinine kinase concentrations during hospitalization were 629 U/L and 361 U/L, for the male and female patient, respectively. The pulmonary capillary wedge pressure was 26 mmHg and 11 mmHg for the male and female patient, respectively. Negative T did not return to normal in the male subject after 6 months. Histopathology results indicated that contraction band necrosis and lymphocyte infiltration were more common in the male subject. CONCLUSIONS: We noticed that possible differences may exist between male and female patients using pathological examination and some DNA analyses. In particular, it may help treat acute severity in males. We will elucidate the mechanism of takotsubo syndrome development by increasing the number of samples to support the reliability of the data in the future.
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Murakami et al. (2021) conducted a case report in Takotsubo syndrome (n=2). Male sex vs. Female sex was evaluated on Pathological and gene expression differences in left ventricular biopsy. In two patients with takotsubo syndrome, the male patient exhibited more severe cardiac injury with contraction band necrosis, lymphocytic infiltration, and altered mitochondrial metabolic gene expression compared to the female patient.
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