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Auton. Res."],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Purpose<\/jats:title>\n            <jats:p>The prevailing hypothesis posits that Takotsubo syndrome (TTS) is caused by massive sympathetic activation, yet supporting evidence remains inconsistent. The objectives of the present study were to determine whether sympathetic activity and reactivity are enhanced in the recovery phase of TTS, and to evaluate the effect of selective \u03b21-receptor blockade on sympathetic reactivity.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>We conducted a case\u2013control study that included 18 female patients with TTS and 13 age- and sex-matched controls. Muscle sympathetic nerve activity was measured through microneurography of the peroneal nerve at rest and during the cold pressor test. In the TTS group, recordings were repeated after randomisation to intravenous metoprolol or placebo. In 10 TTS patients, cardiac sympathetic activity was assessed using iodine\u00a0123-metaiodobenzylguanidine scintigraphy. Blood samples were collected during hospitalisation.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Microneurography was performed a median of 27.5\u00a0days after patient admission. There were no significant differences in burst incidence, burst frequency, burst height or burst area between the TTS patients and the controls at rest, during stress or after administration of intravenous metoprolol. Iodine\u00a0123-metaiodobenzylguanidine scintigraphy was performed a median of 12.5\u00a0days after admission, revealing decreased early 1.54\u2009\u00b1\u20090.13 and late 1.40\u2009\u00b1\u20090.13 heart-to-mediastinum ratios, and an increased washout rate of 41.8\u2009\u00b1\u200912.1%. Catecholamine metabolites were comparable between the study groups.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>General sympathetic hyperactivity or hyperreactivity\u00a0unlikely\u00a0contributes\u00a0to TTS, as catecholamine levels and muscle sympathetic nerve activity at rest and during stress were similar between the TTS patients and the controls.\u00a0As scintigraphy showed increased cardiac sympathetic activity, a pathological cardiac adrenergic response and vulnerability to sympathetic activation\u00a0may be crucial for the development of the syndrome.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s10286-024-01082-9","type":"journal-article","created":{"date-parts":[[2024,11,15]],"date-time":"2024-11-15T09:30:12Z","timestamp":1731663012000},"page":"205-214","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Sympathetic nerve activity and response to physiological stress in Takotsubo syndrome"],"prefix":"10.1007","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4401-7117","authenticated-orcid":false,"given":"Christina","family":"Ekenb\u00e4ck","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas","family":"Persson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per","family":"Tornvall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lena","family":"Forsberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas","family":"Spaak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,11,15]]},"reference":[{"key":"1082_CR1","doi-asserted-by":"publisher","first-page":"2032","DOI":"10.1093\/eurheartj\/ehy076","volume":"39","author":"JR Ghadri","year":"2018","unstructured":"Ghadri JR, Wittstein IS, Prasad A, Sharkey S, Dote K, Akashi YJ, Cammann VL, Crea F, Galiuto L, Desmet W, Yoshida T, Manfredini R, Eitel I, Kosuge M, Nef HM, Deshmukh A, Lerman A, Bossone E, Citro R, Ueyama T, Corrado D, Kurisu S, Ruschitzka F, Winchester D, Lyon AR, Omerovic E, Bax JJ, Meimoun P, Tarantini G, Rihal C, S YH, Migliore F, Horowitz JD, Shimokawa H, Luscher TF, Templin C, (2018) International expert consensus document on takotsubo syndrome (Part I): clinical characteristics, diagnostic criteria, and pathophysiology. 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Jonas Persson has received unrestricted grants from Abbott Inc. Jonas Spaak has received speaker honoraria from AstraZeneca, Sanofi, Boehringer Ingelheim, Novo Nordisk and Bayer, and is a minor shareholder of Beat Vascular Health AB, all outside the present work. Per Tornvall and Lena Forsberg have no relevant financial or non-financial interests to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interests"}},{"value":"This study was performed in accordance with the Declaration of Helsinki and Good Clinical Practice, approved by the Stockholm Regional Board of Ethics (2014\/1856\u201331) and supplemented with approval from the Swedish Ethical Review Authority (2020\u201305104). The study is registered at ClinicalTrials.gov (NCT05768542). All participants provided written informed consent prior to inclusion in the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}