Direct evidences for sympathetic hyperactivity and baroreflex impairment in Tako Tsubo cardiopathy

Angelica Vaccaro, Fabien Despas, Clement Delmas, Olivier Lairez, Elisabeth Lambert, Gavin Lambert, Marc Labrunee, Thibaut Guiraud, Murray Esler, Michel Galinier, Jean Michel Senard, Atul Pathak, Angelica Vaccaro, Fabien Despas, Clement Delmas, Olivier Lairez, Elisabeth Lambert, Gavin Lambert, Marc Labrunee, Thibaut Guiraud, Murray Esler, Michel Galinier, Jean Michel Senard, Atul Pathak

Abstract

Background: The exact pathophysiology of Tako-Tsubo cardiomyopathy (TTC) remains unknown but a role for sympathetic hyperactivity has been suggested. Up to now, no direct evidence of sympathetic nerve hyperactivity has been established nor involvement of sympathetic baroreflex identified. The aim of our study was to determine, by direct sympathetic nerve activity (SNS) recording if sympathetic nervous system activity is increased and spontaneous baroreflex control of sympathetic activity reduced in patients with TTC.

Methods: We included 13 patients who presented with TTC and compared their SNS activity and spontaneous baroreflex control of sympathetic activity with that of 13 control patients with acutely decompensated chronic heart failure. SNS activity was evaluated by microneurography, a technique assessing muscle sympathetic nerve activity (MSNA). Spontaneous baroreflex control of sympathetic activity was evaluated as the absolute value of the slope of the regression line representing the relationship between spontaneous diastolic blood pressure values and concomitant SNS activity. Control patients were matched for age, sex, left ventricular ejection fraction and creatinine clearance.

Results: The mean age of the patients with TTC was 80 years, all patients were women. There were no significant differences between the two groups of patients for blood pressure, heart rate or oxygen saturation level. TTC patients presented a significant increase in sympathetic nerve activity (MSNA median 63.3 bursts/min [interquartile range 61.3 to 66.0] vs median 55.7 bursts/min [interquartile range 51.0 to 61.7]; p = 0.0089) and a decrease in spontaneous baroreflex control of sympathetic activity compared to matched control patients (spontaneous baroreflex control of sympathetic activity median 0.7%burst/mmHg [interquartile range 0.4 to 1.9] vs median 2.4%burst/mmHg [interquartile range 1.8 to 2.9]; p = 0.005).

Conclusions: We report for the first time, through direct measurement of sympathetic nerve activity, that patients with TTC exhibit elevated SNS activity associated with a decrease in spontaneous baroreflex control of sympathetic activity. These data may explain the pathophysiology and clinical presentation of patient with TTC.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Example of a spontaneous baroreflex…
Figure 1. Example of a spontaneous baroreflex control of sympathetic activity determination.
In this figure there is an example, in one chronic heart failure patient, of the regression line describing the relationship between Muscle Sympathetic Nervous Activity (MSNA) expressed as burst/100 heart beats (on ordinates) and concomitants spontaneous diastolic blood pressure values (on abscissae). The spontaneous baroreflex control of sympathetic activity was defined as the absolute value of this regression line.
Figure 2. Comparison between a Tako Tsubo…
Figure 2. Comparison between a Tako Tsubo patient and a heart failure control patient.
In this figure are showed: microneurographic recording, Muscle Sympathetic Nerve Activity (MSNA) values, Systolic and Diastolic Blood Pressure (SBP, DBP) values and spontaneous baroreflex control of sympathetic activity values in one Tako-Tsubo patient (on the left) and one chronic heart failure patient (on the right). The microneurographic recording well show the increased frequency of sympathetic bursts and then sympathetic activity in Tako-Tsubo patient compared to control.
Figure 3. Comparison of MSNA activity between…
Figure 3. Comparison of MSNA activity between Tako Tsubo patients and CHF control patient.
In this figure we show the comparison of mean MSNA activity, expressed in burst/min, between 13 TTC patients (on the left) and 13 acutely decompensated CHF patients (on the right).
Figure 4. Comparison of the spontaneous baroreflex…
Figure 4. Comparison of the spontaneous baroreflex control of sympathetic activity between TTC and CHF patients.
In this figure we show the comparison of the spontaneous baroreflex control of sympathetic activity of a single TTC patient (on the right) and a single CHF control patient (on the left).

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