{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T13:10:12Z","timestamp":1779455412650,"version":"3.53.1"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Takotsubo cardiomyopathy (TTC) is an acute heart condition in which physical or emotional stress causes left ventricular dysfunction. Psychiatric comorbidities have been linked to the precipitation of this condition, but large-scale data are limited. The goal of this study was to analyze the associations between TTC and various psychiatric conditions using nationally representative data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A retrospective observational cohort study was conducted using the Nationwide Inpatient Sample database from 2016 to 2022. International Classification of Diseases, Tenth Revision code I51.81 was used to identify hospitalized patients \u226518 years with a primary diagnosis of TTC. In addition, International Classification of Diseases, Tenth Revision codes were used to identify patients diagnosed with various psychiatric comorbidities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      A total of 291,600 patients had a primary diagnosis of TTC. The mean age was 67.1\u2009\u00b1\u200914.26 years, and 82.04% of the population was female. The following 4 psychiatric comorbidities were found to have significant associations with TTC: nicotine dependence [17.48% of patients;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001; odds ratio (OR), 1.08; 95% confidence intervals (CI), 1.06\u20131.11], depressive disorders (19.20% of patients;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001; OR, 1.46; 95% CI, 1.43\u20131.49), anxiety (24.25% of patients;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001; OR, 1.83; 95% CI, 1.80\u20131.87), and post traumatic stress disorder (2.91% of patients;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001; OR, 1.25; 95% CI, 1.18\u20131.31). No significant associations were found for dementia, alcohol related disorders, substance use other than tobacco and alcohol, manic disorders, or schizophrenia.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>In this large, nationally representative sample, nicotine dependence, anxiety, depression, and post traumatic stress disorder were significantly associated with TTC. These findings highlight the importance of incorporating psychiatric health practices into the field of cardiology.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/hpc.0000000000000421","type":"journal-article","created":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T13:00:49Z","timestamp":1779454849000},"page":"e0421","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Various Psychiatric Comorbidities and Smoking Appear to be Associated With Takotsubo Cardiomyopathy: A Nationwide Analysis From 2016 to 2022"],"prefix":"10.1097","volume":"25","author":[{"given":"Ryan","family":"Hassen","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Arizona College of Medicine- Phoenix, Phoenix, AZ"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehrtash","family":"Hashemzadeh","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Arizona College of Medicine- Phoenix, Phoenix, AZ"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Reza","family":"Movahed","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Arizona College of Medicine- Phoenix, Phoenix, AZ"},{"name":"Department of Medicine, University of Arizona Sarver Heart Center, Tucson, AZ."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,3,16]]},"reference":[{"key":"R1-20260522","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1056\/NEJMoa1406761","article-title":"Clinical features and outcomes of takotsubo (Stress) cardiomyopathy.","volume":"373","author":"Templin","year":"2015","journal-title":"N Engl J Med"},{"key":"R2-20260522","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1111\/j.1751-7133.2010.00188.x","article-title":"Reverse or inverted takotsubo cardiomyopathy (Reverse Left Ventricular Apical Ballooning Syndrome) presents at a younger age compared with the mid or apical variant and is always associated with triggering stress.","volume":"16","author":"Ramaraj","year":"2010","journal-title":"Congest Heart Fail"},{"key":"R3-20260522","first-page":"6","article-title":"Levels of troponin release can aid in the early exclusion of stress-induced (takotsubo) cardiomyopathy.","volume":"14","author":"Ramaraj","year":"2009","journal-title":"Exp Clin Cardiol"},{"key":"R4-20260522","doi-asserted-by":"crossref","first-page":"902","DOI":"10.1016\/j.jacc.2020.10.060","article-title":"Pathophysiology of takotsubo syndrome.","volume":"77","author":"Lyon","year":"2021","journal-title":"J Am Coll Cardiol"},{"key":"R5-20260522","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/j.carrev.2007.02.001","article-title":"Review: transient left ventricular apical ballooning, broken heart syndrome, ampulla cardiomyopathy, atypical apical ballooning, or Tako-Tsubo cardiomyopathy.","volume":"8","author":"Movahed","year":"2007","journal-title":"Cardiovasc Revasc Med"},{"key":"R6-20260522","doi-asserted-by":"crossref","first-page":"917","DOI":"10.3389\/fneur.2019.00917","article-title":"Takotsubo cardiomyopathy\u2014acute cardiac dysfunction associated with neurological and psychiatric disorders.","volume":"10","author":"Buchmann","year":"2019","journal-title":"Front Neurol"},{"key":"R7-20260522","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1007\/s10286-017-0465-z","article-title":"Epidemiology, pathogenesis, and management of takotsubo syndrome.","volume":"28","author":"Y-Hassan","year":"2018","journal-title":"Clin Auton Res"},{"key":"R8-20260522","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1016\/j.amjmed.2014.04.004","article-title":"Takotsubo syndrome (stress cardiomyopathy): an intriguing clinical condition in search of its identity.","volume":"127","author":"Pelliccia","year":"2014","journal-title":"Am J Med"},{"key":"R9-20260522","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1253\/circj.CJ-12-0759","article-title":"Anxiodepressive disorders and chronic psychological stress are associated with tako-tsubo cardiomyopathy: \u2013new physiopathological hypothesis\u2013.","volume":"77","author":"Delmas","year":"2013","journal-title":"Circ J"},{"key":"R10-20260522","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.genhosppsych.2020.05.010","article-title":"Psychiatric conditions in patients presenting with Takotsubo syndrome: a systematic review and synthesis of case studies.","volume":"65","author":"Carroll","year":"2020","journal-title":"Gen Hosp Psychiatry"},{"key":"R11-20260522","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1111\/j.1540-8175.2007.00604.x","article-title":"Reverse or inverted left ventricular apical ballooning syndrome (reverse takotsubo cardiomyopathy) in a young woman in the setting of amphetamine use.","volume":"25","author":"Movahed","year":"2008","journal-title":"Echocardiogr"},{"key":"R12-20260522","doi-asserted-by":"crossref","first-page":"2032","DOI":"10.1093\/eurheartj\/ehy076","article-title":"International expert consensus document on takotsubo syndrome (part I): clinical characteristics, diagnostic criteria, and pathophysiology.","volume":"39","author":"Ghadri","year":"2018","journal-title":"Eur Heart J"},{"key":"R13-20260522","doi-asserted-by":"crossref","first-page":"829","DOI":"10.4065\/81.6.829","article-title":"Transient left ventricular apical ballooning after cocaine use: is catecholamine cardiotoxicity the pathologic link?","volume":"81","author":"Arora","year":"2006","journal-title":"Mayo Clin Proc"},{"key":"R14-20260522","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1056\/NEJMoa043046","article-title":"Neurohumoral features of myocardial stunning due to sudden emotional stress.","volume":"352","author":"Wittstein","year":"2005","journal-title":"N Engl J Med"},{"key":"R15-20260522","doi-asserted-by":"crossref","first-page":"e019583","DOI":"10.1161\/JAHA.120.019583","article-title":"Sex\u2010 and age\u2010based temporal trends in takotsubo syndrome incidence in the United States.","volume":"10","author":"Pattisapu","year":"2021","journal-title":"J Am Heart Assoc"},{"key":"R16-20260522","doi-asserted-by":"crossref","first-page":"925459","DOI":"10.3389\/fcvm.2022.925459","article-title":"Pre-existing psychiatric morbidity is strongly associated to takotsubo syndrome: a case-control study.","volume":"9","author":"Pozzi","year":"2022","journal-title":"Front Cardiovasc Med"},{"key":"R17-20260522","doi-asserted-by":"crossref","first-page":"1334","DOI":"10.1089\/jwh.2021.0557","article-title":"The association of mental health disorders with takotsubo syndrome (broken heart syndrome) among older women.","volume":"31","author":"Appiah","year":"2022","journal-title":"J Womens Health (Larchmt)"},{"key":"R18-20260522","doi-asserted-by":"crossref","first-page":"26","DOI":"10.2174\/1745017901814010026","article-title":"Takotsubo syndrome is associated with mood disorders and antidepressants use, not with anxiety and impairment of quality of life due to the psychiatric disorder.","volume":"14","author":"Sancassiani","year":"2018","journal-title":"Clin Pract Epidemiol Ment Health"},{"key":"R19-20260522","doi-asserted-by":"crossref","first-page":"102429","DOI":"10.1016\/j.cpcardiol.2024.102429","article-title":"Takotsubo cardiomyopathy and psychiatric illness- insight from National Inpatient Sample (NIS) and National Re-admission Database (NRD) 2016 to 2018.","volume":"49","author":"Gonuguntla","year":"2024","journal-title":"Curr Probl Cardiol"},{"key":"R20-20260522","doi-asserted-by":"crossref","first-page":"1282018","DOI":"10.3389\/fcvm.2023.1282018","article-title":"Smoking influence in Takotsubo syndrome: insights from an international cohort.","volume":"10","author":"N\u00fa\u00f1ez-Gil","year":"2023","journal-title":"Front Cardiovasc Med"},{"key":"R21-20260522","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.ahj.2012.03.020","article-title":"Prevalence of Takotsubo cardiomyopathy in the United States.","volume":"164","author":"Deshmukh","year":"2012","journal-title":"Am Heart J"},{"key":"R22-20260522","first-page":"e202206","article-title":"Takotsubo cardiomyopathy secondary to alcohol withdrawal.","volume":"2022","author":"Ahmed","year":"2022","journal-title":"Glob Cardiol Sci Pract"},{"key":"R23-20260522","first-page":"193","article-title":"Takotsubo cardiomyopathy in the setting of acute alcohol withdrawal.","volume":"71","author":"Stout","year":"2012","journal-title":"Hawaii J Med Public Health"},{"key":"R24-20260522","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1161\/CIRCULATIONAHA.112.111591","article-title":"High Levels of circulating epinephrine trigger apical cardiodepression in a \u03b22 -Adrenergic Receptor\/Gi\u2013Dependent manner: a new model of takotsubo cardiomyopathy.","volume":"126","author":"Paur","year":"2012","journal-title":"Circulation"},{"key":"R25-20260522","doi-asserted-by":"crossref","first-page":"1898","DOI":"10.1093\/eurheartj\/ehab029","article-title":"Stress-associated neurobiological activity associates with the risk for and timing of subsequent Takotsubo syndrome.","volume":"42","author":"Radfar","year":"2021","journal-title":"Eur Heart J"},{"key":"R26-20260522","doi-asserted-by":"crossref","first-page":"1581","DOI":"10.1161\/CIRCULATIONAHA.118.037975","article-title":"Myocardial and systemic inflammation in acute stress-induced (takotsubo) cardiomyopathy.","volume":"139","author":"Scally","year":"2019","journal-title":"Circulation"},{"key":"R27-20260522","doi-asserted-by":"crossref","first-page":"4127","DOI":"10.1093\/eurheartj\/ehaf441","article-title":"Takotsubo syndrome: cognitive behavioural therapy, physical training, and brain function recovery in the BREAKOUT trial.","volume":"46","author":"Khan","year":"2025","journal-title":"Eur Heart J"},{"key":"R28-20260522","first-page":"1160","article-title":"Survival and risk of recurrence of takotsubo syndrome.","volume":"107","author":"Lau","year":"2021","journal-title":"Heart (British Cardiac Society)"},{"key":"R29-20260522","first-page":"476","article-title":"Beta-blockers and renin-angiotensin system inhibitors for Takotsubo syndrome recurrence: a network meta-analysis.","volume":"110","author":"Santoro","year":"2024","journal-title":"Heart (British Cardiac Society)"}],"container-title":["Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/HPC.0000000000000421","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T13:00:53Z","timestamp":1779454853000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/HPC.0000000000000421"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,16]]},"references-count":29,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.1097\/hpc.0000000000000421","relation":{},"ISSN":["1535-2811"],"issn-type":[{"value":"1535-2811","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,16]]}}}