M. Cattaneo1, M. M. Cattaneo2, E. Pravatà3, M. Provenzi4, M. Moccetti3, A. Kaelin3, I. Sudano5, F. Crea6, L. Biasucci6, C. Limoni3, C. Calanchini7, A. Gallino8 (1Bellinzona / Lugano ; 2 Bellinzona ; 3Lugano ; 4Stabio ; 5Zurich ; 6Rome IT; 7Castelrotto ; 8Bellinzona / Zurich)
Purpose. We hypothesized that Tako-Tsubo syndrome (TTS) and primary microvascular angina (MVA) may exhibit peculiar functional organization of the central autonomic nervous system network (CAN) at rest, as well as specific psychological patterns as compared to patients with acute myocardial infarction (AMI).
Design & methods. We prospectively enrolled patients in 3 groups: MVA, after TTS or AMI. Subjects underwent a clinical-diagnostic interview, Millon Clinical Multiaxial Inventory III, State-Trait Anxiety Inventory form Y, short form (SF-36) Health Survey related to quality of life questionnaire. Patients underwent a blinded resting state functional MRI (RS-fMRI), to compare the intrinsic connectivity strength among the CAN nodes.
Results. We evaluated 50 (46 women) matched patients (16 MVA, 17 TTS, 17 AMI). There was a high prevalence of obsessive-compulsive personality disorder. MVA showed a significantly lower SF-36 Body-Pain score than AMI (p 0.046) and a significantly higher SF-36 Mental-Health score than AMI (p 0.039). RS-fMRI in TTS showed stronger connectivity between two nodes of the sympathetic (midcingulate cortex) and parasympathetic (sub-central motor area) CAN (F 6.25, p 0.005).
Conclusions. The peculiar self-reported body pain and mental health in MVA as well as the increased level of functional integration between areas of the CAN subdivisions in TTS may link psychosocial distress with clinical manifestations. This data are hypothesis-generating for future potential endorsement of psychotherapy and stress-reducing techniques as therapeutic strategies.