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  1. Goh, Anne C. H. MD, MPH
  2. Wong, Stephanie DO
  3. Zaroff, Jonathan G. MD
  4. Shafaee, Navid MD
  5. Lundstrom, Robert J. MD


PURPOSE: To determine whether anxiety or depression is associated with takotsubo stress cardiomyopathy (TSCM).


METHODS: A retrospective case-control study was conducted among 73 TSCM cases and 111 acute coronary syndrome (ACS) controls matched for age, sex, and cardiac catheterization date. The study was conducted between May 1, 2009, and February 28, 2010. The Hospital Anxiety and Depression Scale was completed by all participants after hospital discharge. The Hospital Anxiety and Depression Scale was used to assess psychological distress with measurement of anxiety and depression scores. The presence of a stressful emotional or physical trigger before the TSCM presentation was determined. Univariate testing was performed to quantify the associations between anxiety and depression and TSCM trigger status. Multivariable logistic regression was used to quantify the independent associations between anxiety and depression and TSCM status after controlling for relevant covariates.


RESULTS: The mean anxiety score was 6.7 +/- 4.7 for TSCM cases versus 5.4 +/- 3.4 for ACS controls (P = .06). The mean depression score was 4.3 +/- 3.7 for TSCM cases versus 4.0 +/- 3.1 for controls (P = .61). Anxiety was particularly associated with TSCM status with an emotional trigger (P = .05). After multivariable adjustment, anxiety (OR = 1.13; 95% CI, 1.01-1.26; P = .03) was associated with TSCM status but depression was not (OR = 0.94; 95% CI, 0.83-1.05; P = .29).


CONCLUSIONS: In comparison with a control group with ACS, patients who presented with TSCM have higher levels of anxiety but not depression.