Stress and resilience in women with Takotsubo syndrome: Admin Supplement

项目总结/摘要 Takotsubo综合征（TS）是一种日益被认识的疾病，其特征是急性、可逆性收缩期 心力衰竭，超过90%的病例影响绝经后妇女。虽然大多数病人都能康复 急性发作后，存活者发生长期主要脑血管事件（MACCE）和 左心室（LV）功能的慢性损害。虽然人们普遍认为， 交感神经系统（SNS）反应是TS发作的基础，其生理病理学 被低估的条件仍然没有完全理解，首先，暴露于情绪触发被认为是 是TS的决定性诱因，但最近的登记数据表明， 仅在1/3的情况下，物理触发（1/3）和无触发（1/3）占其余情况。 第二，机制途径连接的触发TS的发作仍有待阐明。 第三，目前还不清楚为什么只有某些人在接触社交网络时会产生夸张的反应。 影响所有人一生的情绪触发因素，而不会对健康产生影响。终于没有 一项研究严格测试了触发事件和精神压力反应对长期- 这些患者的长期预后。为了解决这些差距，我们将招募106名新入院的患者， 来自RI地区普罗维登斯的3个大型医疗中心的TS的有效诊断。参与者将被 出院后4周内筛选合格性。在提供知情同意书后，他们将 进行全面的访谈，以确定TS发作的近端事件，完成一系列 心理社会问卷调查，并接受实验室精神压力协议。基线和反应性变化 在自主神经系统活动（循环儿茶酚胺和心脏迷走神经控制）的测量中，LV 功能（射血分数，通过斑点追踪超声心动图（STE）评价的总体纵向应变） 将被评估。12个月后将再次评估LV功能，届时将提供以下信息 将收集MACCE。拟议的研究将通过以下方式解决所指出的证据差距：a）严格 评估接近TS发作的全部情况，B）评估生理学的星座， 定义TS的元素（即，自主神经系统活动和LV功能）， 以及c）将触发类型和对压力的反应与预后联系起来。值得注意的是，通过使用STE， 捕获这些患者左心室功能的反应性和长期细微异常。这将是第一 本研究旨在严格调查TS的临床表现、病理生理学和预后的异质性。 确定TS中的不同亚组将为制定适当针对性的 干预措施，以改善这些患者的预后。

PROJECT SUMMARY/ABSTRACT Takotsubo syndrome (TS) is an increasingly recognized condition characterized by acute, reversible systolic heart failure which affects post-menopausal women in over 90% of cases. Although most patients recover after an acute episode, survivors have a high risk of long-term major cerebrovascular events (MACCE) and of chronic impairment of the left ventricular (LV) function. While there is a general consensus that an exaggerated sympathetic nervous system (SNS) response underlies the onset of TS, the physiopathology of this underappreciated condition is still incompletely understood, First, exposure to an emotional trigger was thought to be a defining precipitant of TS, but recent registry data indicate instead that emotional triggers are present only in 1/3 of cases, with physical triggers (1/3) and no triggers (1/3) accounting for the remaining cases. Second, the mechanistic pathway linking the precipitating trigger to the onset of TS remains to be articulated. Third, it is unclear why only certain individuals develop an exaggerated SNS response when exposed to emotional triggers which affect all individuals throughout the lifespan with no health consequences. Finally, no study has rigorously tested the contribution of triggering event and mental stress responsiveness to the long- term prognosis of these patients. To address these gaps, we will enroll 106 patients admitted with a new validated diagnosis of TS from 3 large medical centers in the Providence, RI area. Participants will be screened for eligibility within 4 weeks since hospital discharge. After providing informed consent, they will undergo a comprehensive interview to identify the events proximal to the onset of TS, complete a battery of psychosocial questionnaires and undergo a laboratory mental stress protocol. Baseline and reactive changes in measures of autonomic nervous system activity (circulating catecholamines and cardiac vagal control), LV function (ejection fraction, Global Longitudinal Strain evaluated by speckle tracking echocardiography (STE)) will be assessed. LV function will be assessed again 12 months later and at that time information about MACCE will be collected. The proposed study will address the noted evidence gaps by a) Rigorously assessing the full range of circumstances proximal to TS onset, b) Assessing the constellation of physiological elements that define TS (i.e., autonomic nervous system activity and LV function) under controlled conditions, and c) Link the type of trigger and response to stress to prognosis. Notably, by using STE, we will be able to capture both reactive and long-term subtle anomalies of LV function in these patients. This will be the first study to rigorously investigate the heterogeneity in clinical presentation, physiopathology, and prognosis in TS. The identification of distinct sub-groups in TS will provide the rationale for the development of properly targeted interventions to improve the prognosis of these patients.