# Stress and resilience in women with Takotsubo syndrome: Admin Supplement

> **NIH NIH R01** · MIRIAM HOSPITAL · 2022 · $9,870

## Abstract

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 th...

## Key facts

- **NIH application ID:** 10609696
- **Project number:** 3R01HL149672-03S1
- **Recipient organization:** MIRIAM HOSPITAL
- **Principal Investigator:** Elena Salmoirago-Blotcher
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $9,870
- **Award type:** 3
- **Project period:** 2020-03-01 → 2025-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10609696

## Citation

> US National Institutes of Health, RePORTER application 10609696, Stress and resilience in women with Takotsubo syndrome: Admin Supplement (3R01HL149672-03S1). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10609696. Licensed CC0.

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