A new study reveals possible mechanisms that may contribute to “broken heart syndrome” or Takotsubo syndrome (TTS), a temporary heart disease caused by stressful situations and emotions. Research, conducted by investigators at the Harvard-affiliated Massachusetts General Hospital (MGH), shows that a heart-brain connection likely plays an important role.
For the study published in the European Heart Journal, the team analyzed imaging scans of 104 patients (41 who later developed TTS and 63 who didn’t) to determine whether increased stress-related metabolic activity in the brain led to an increased risk of developing TTS.
“Areas of the brain with higher metabolic activity tend to be used more often. Higher activity in the stress-associated centers of the brain suggests that the individual is more actively responding to stress, ”said senior author Ahmed Tawakol, director of nuclear cardiology and co-director of the research center for cardiovascular imaging at MGH.
The imaging tests, performed on patients for other medical reasons, showed that increased activity in the brain’s amygdala predicted the development of subsequent TTS as well as the timing of the syndrome. For example, people with the highest amygdalar activity developed TTS within one year of imaging, while those with intermediate levels developed TTS a few years later.
“We show that TTS doesn’t just happen because you run into a rare, terribly disruptive event – like the death of a spouse or child, as the classic examples have. Rather, people with high levels of stress-related brain activity seem prepared to develop TTS – and can develop the syndrome if exposed to more frequent stressors, even a routine colonoscopy or a broken bone, “Tawakol said.
The scientists also identified a link between stress-related brain activity and bone marrow activity in individuals. Because the bone marrow produces different types of blood cells that are involved in transporting oxygen, increasing immune responses, and blood clotting, stress-related brain activity can affect the activity of cells that affect cardiovascular health.
Applying the results to the clinic, Tawakol hopes that interventions that lower stress-related brain activity will make TTS more difficult to develop. “Studies should test whether such approaches to reducing stress-related brain activity reduce the likelihood of TTS recurring in patients with previous TTS episodes,” he said. He also highlighted the need for further study of the effects of stress reduction – or drug interventions that target stress-related brain activity – on heart health.
Once published, the paper will be published on the European Heart Journal website Here.
This work was supported by the National Institutes of Health and the American Heart Association. Support also came from the Osher Center at Harvard Medical School and from A. Curtis Greer and Pamela Kohlberg.