{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:37:57Z","timestamp":1786977477393,"version":"build-2736575974"},"reference-count":41,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2021,9,7]],"date-time":"2021-09-07T00:00:00Z","timestamp":1630972800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Cardiology"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>It is well\u2010accepted that takotsubo syndrome (TS) is characterized by a massive surge of plasma catecholamines despite lack of solid evidence. The objective of this study was to examine the hypothesis of a massive catecholamine elevation in TS by studying plasma\u2010free catecholamine metabolites in patients participating in the Stockholm myocardial infarction (MI) with normal coronaries 2 (SMINC\u20102) study where TS constituted more than one third of the patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>The patients included in the SMINC\u20102 study were classified, according to cardiac magnetic resonance (CMR) imaging findings (148 patients), which was performed at a median of 3\u2009days after hospital admission. Plasma\u2010free catecholamine metabolites; metanephrine, normetanephrine, and methoxy\u2010tyramine were measured on day 2\u20134 after admission. Catecholamine metabolite levels were available in 125 patients. One hundred and ten (88%) of the 125 patients included in SMINC\u20102 study, and 38 (86.4%) of the 44 patients with TS had completely normal plasma metanephrine and normetanephrine levels. All patients had normal plasma methoxy\u2010tyramine levels. Fourteen (11.2%) of the 125 patients included in SMINC\u20102 study, and 5 (11.6%) of the 43 patients with TS had mild elevations (approximately 1.2 times the upper normal limits) of either plasma metanephrine or normetanephrine. One patient with pheochromocytoma\u2010triggered TS had marked elevation of plasma metanephrine and mild elevation of plasma normetanephrine. There were no significant differences between the number or degree of catecholamine metabolite elevations between the different groups of patients with CMR imaging diagnosis included in SMINC\u20102 study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>There was no evidence of massive catecholamine elevations in the acute and subacute stages of TS apart from one patient with pheochromocytoma\u2010induced TS. Most of the TS patients had normal catecholamine metabolites indicating that blood\u2010borne catecholamines do not play a direct role in the pathogenesis of TS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/clc.23723","type":"journal-article","created":{"date-parts":[[2021,9,7]],"date-time":"2021-09-07T05:29:13Z","timestamp":1630992553000},"page":"1567-1574","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Plasma catecholamine levels in the acute and subacute stages of takotsubo syndrome: Results from the Stockholm myocardial infarction with normal coronaries 2 study"],"prefix":"10.1002","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5228-9035","authenticated-orcid":false,"given":"Shams","family":"Y\u2010Hassan","sequence":"first","affiliation":[{"name":"Coronary Artery Disease Area, Heart and Vascular Theme Karolinska Institute and Karolinska University Hospital  Stockholm 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