Psychological Characteristics of Patients with Takotsubo Syndrome and Patients with Acute Coronary Syndrome: An Explorative Study toward a Better Personalized Care.

During an acute cardiac event, Takotsubo Syndrome (TTS) and Acute Coronary Syndrome (ACS) apparently share very similar clinical characteristics. Since only a few inconsistent studies have evaluated the psychological features that characterize these different patients, the aim of the present explorative research was to investigate if post-recovery TTS and ACS patients present different psychological profiles. We also investigated whether the occurrence of acute psychological stressful episodes that had occurred prior to the cardiac event could be found in either syndrome. Twenty TTS and twenty ACS female patients were recruited. All patients completed self-report questionnaires about anxiety and depressive symptoms, perceived stress, type-D personality and post-traumatic symptoms. Results showed that only three subscales of health anxiety (i.e., Fear of Death/Diseases, Interference and Reassurance) significantly differed between the two groups, while no differences were found in the other psychological measurements. Moreover, personality traits seem to not be associated with the impact of the cardiac traumatic event. Finally, only TTS patients reported the presence of a significant emotional trigger preceding the acute cardiac event. In conclusion, post-recovery TTS patients differ from ACS patients in their level of concern about their health and in their need of reassurance and information only, probably as a result of the different clinical characteristics of the two illnesses.

Unreliability of the %VO2 reserve versus %heart rate reserve relationship for aerobic effort relative intensity assessment in chronic heart failure patients on or off beta-blocking therapy.

BACKGROUND: Percentage of heart rate reserve (%HRR) has been shown to be equivalent to percentage of VO2 reserve (%VO2R) in normal individuals, but it is not clear whether this is also true for chronic heart failure (CHF) patients. DESIGN: This study aimed to evaluate the reliability of the %VO2R versus %HRR relationship for aerobic effort relative intensity assessment in CHF patients. METHODS: We studied 388 patients with CHF, of whom 213 were on carvedilol (CHF on betab) and 175 were off the drug (CHF off betab), and 40 normal individuals (N). %VO2R and %HRR values were evaluated at matched steps during cardiopulmonary exercise testing. The %VO2R versus %HRR regression was determined for each group (CHF, CHF on betab, CHF off betab, N) as a whole and as the mean of individual regressions. RESULTS: %VO2R strongly correlated with %HRR in both N and CHF, at both group and mean individual regressions, with slope and y-intercept values significantly lower and higher, respectively, in CHF than N. The 95% prediction interval of %VO2R for a given %HRR value was 24% points in N but rose to 41 in CHF, and the mean regression line coincided with identity line in N but not in CHF. These results were independent of beta-blockade. CONCLUSIONS: In CHF patients the %VO2R versus %HRR relationship is unreliable for assessment of aerobic effort relative intensity, because of a large prediction interval of %VO2R and lack of coincidence with the identity line, independently of beta-blocking therapy. This implies that the %VO2R versus %HRR relationship should be determined directly in each patient.