Key result
Long-lasting psychological distress and lifetime anxiety appear to be significantly associated with Takotsubo syndrome, while evidence for acute stressful life events or trauma as triggers remains conflicting.
Why the study?
Takotsubo syndrome has been historically linked to psychological factors, but their specific role required systematic review and evaluation.
Do psychological factors such as stressful life-events, psychopathology, and personality characteristics play a role in Takotsubo syndrome compared to other heart diseases or healthy controls?
Systematic Review (n=2,581)
Do psychological factors such as stressful life-events, psychopathology, and personality characteristics play a role in Takotsubo syndrome compared to other heart diseases or healthy controls?
This systematic review highlights that while long-lasting psychological distress and anxiety are consistently associated with Takotsubo syndrome, evidence regarding acute stressful life-events and personality traits remains conflicting due to methodological limitations in existing studies.
Warrants psychological screening in Takotsubo patients; confirms chronic distress links while leaving acute triggers unresolved.
OBJECTIVE: Takotsubo syndrome (TTS) is a transient heart disease that has been historically related to the occurrence of psychological (emotional) factors ("broken heart" syndrome). We aimed to conduct a systematic review analyzing the role of psychological factors in TTS. METHODS: All studies on TTS and psychological factors from January 1991 through April 2019 were scrutinized according to the Cochrane Collaboration and the PRISMA statements. Selected studies were additionally evaluated for the Risk of Bias according to the Newcastle-Ottawa Scale (NOS). RESULTS: Fifteen case-control studies (by Mayo Clinic criteria) were finally selected. Most studies analyzed stressful life-events or trauma, although with conflicting findings, while a likely role of long-lasting psychological distress seemed to be a homogenous result. Among life-time psychopathology, only anxiety appeared to have a significant role. Some studies outlined a likely role of personality, but findings are conflicting. CONCLUSION: Our findings do not lead to any definitive assumption on the specific role of psychological factors in TTS, also for scant strong methodology of the most part of the studies. More studies with stronger research methodology are needed to better characterize psychological elements in TTS.
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Galli et al. (2019) conducted a systematic review in Takotsubo syndrome (n=2,581). Psychological factors (stressful life-events, psychopathology, personality) vs. Healthy controls or patients with other heart diseases was evaluated on Association of psychological factors with Takotsubo syndrome. Long-lasting psychological distress and lifetime anxiety appear to be significantly associated with Takotsubo syndrome, while evidence for acute stressful life events or trauma as triggers remains conflicting.
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