Takotsubo syndrome – A close connection to the brain: A prospective study investigating neuropsychiatric traits

•Persisting symptoms despite recovery of cardiac function is common.•TTC patients show good neuropsychologic functioning, but there is high prevalence of fatigue.•Psychiatric comorbidities seem to be under-diagnosed in patients newly diagnosed with TTC.

BackgroundTakotsubo syndrome (TTS) is frequently triggered by a stressful event. Overactivation of the sympathetic nervous system has been hypothesized as the underlying mechanism. In a prospective, cross-sectional, single center study we aimed to investigate neuropsychiatric traits in patients with TTS.MethodsTwenty-six patients with TTS with a median latency of 17.5 months from their index event underwent detailed medical examination, neuropsychologic examination, and Holter-ECG and were screened for psychiatric comorbidities, chronic stress and personality traits with questionnaires.Results38.5% (10/26) of patients suffered from a neurological disease, and 50.0% (13/26) from at least one mental disorder. In 23.1% (6/26) the hospital anxiety scale (HADS–A) was suspicious for an anxiety disorder. There was a high prevalence of left-handedness (19.2%; 5/26). Despite good performance in cognitive testing, 11 patients had an abnormal score in the fatigue severity scale. Recovery of cardiac function was documented, although symptoms in 69.2% of patients persisted. An increase in the root mean square of the successive differences (RMSSD) (p = 0.01) was noted on the Holter-ECG.ConclusionThe study highlights a high prevalence of psychiatric and neurologic comorbidities in patients with TTS, which so far have been under-diagnosed. Future studies will have to show whether these patients might benefit from a combined psychocardiologic rehabilitation.