{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,16]],"date-time":"2025-07-16T12:24:34Z","timestamp":1752668674199,"version":"3.37.3"},"reference-count":11,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2022,3,23]],"date-time":"2022-03-23T00:00:00Z","timestamp":1647993600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001516","name":"National Heart Foundation of New Zealand","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001516","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objectives<\/jats:title>\n<jats:p>The most perfect example of the mind-body interaction in all of medicine is provided by stress cardiomyopathy. In stress cardiomyopathy, what is initially a purely emotional event may become rapidly fatal. Prolongation of the QT interval is a cardinal feature of the condition, but the mechanism of the prolongation is unknown. We undertook a randomised controlled trial of stress with a cross-over design, comparing the cardiac response of women with a history of stress cardiomyopathy to age-matched controls to explore the mind-body interaction. Our hypothesis is that the hearts of women with a history of stress cardiomyopathy will respond differently to emotional stress than those of the controls.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Method<\/jats:title>\n<jats:p>This is a randomised cross-over study. Each patient underwent two separate 24-hour Holter monitors performed at least 5 days apart. Baseline recording was followed by either the stress intervention (hyperventilation) or control (diaphragmatic breathing). Our primary endpoint is change in QTc interval over the first hour. Secondary endpoints were change in QTc over 24 hours, and change in SDNN, a measure of heart rate variability. As a secondary stressor, each participant was telephoned four times during their stressed recording and asked to complete a questionnaire.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Twelve stress cardiomyopathy patients and twelve control patients were recruited. Baseline characteristics did not differ between cases and controls. With hyperventilation, there was a significant initial difference in anxiety (p&lt;0.001), heart rate response (p&lt;0.0001), and QTc (p&lt;0.0002) compared to diaphragmatic breathing, but no differences between the cases and controls. Only first phone call caused an increase in QTc in cases and controls (p = 0.0098). SDNN increased with hyperventilation (p&lt;0.0001) but did not differ between cases and controls.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>QTc response in women with a history of stress cardiomyopathy does not differ from controls. The relevance of QT prolongation and sensitivity in the autonomic response to the pathogenesis of stress cardiomyopathy remains uncertain.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0265607","type":"journal-article","created":{"date-parts":[[2022,3,23]],"date-time":"2022-03-23T17:32:46Z","timestamp":1648056766000},"page":"e0265607","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["A randomised cross-over trial of QT response to hyperventilation-induced anxiety and diaphragmatic breathing in patients with stress cardiomyopathy and in control patients"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9016-4890","authenticated-orcid":true,"given":"George M.","family":"Watson","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacalin","family":"Sutherland","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cameron","family":"Lacey","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul G.","family":"Bridgman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2022,3,23]]},"reference":[{"issue":"4","key":"pone.0265607.ref001","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1016\/j.hfc.2016.06.003","article-title":"A clinical perspective of the takotsubo syndrome","volume":"12","author":"S. Sharkey","year":"2016","journal-title":"Heart Failure Clinics"},{"key":"pone.0265607.ref002","doi-asserted-by":"crossref","first-page":"e025253","DOI":"10.1136\/bmjopen-2018-025253","article-title":"Comparing the variants of takotsubo syndrome: an observational study of the ECG and structural changes from a New Zealand tertiary hospital","volume":"9","author":"GM Watson","year":"2019","journal-title":"BMJ Open"},{"issue":"3","key":"pone.0265607.ref003","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1111\/j.1542-474X.2007.00169.x","article-title":"Mental stress may induce QT interval prolongation and T-wave notching","volume":"12","author":"G Andr\u00e1ssy","year":"2007","journal-title":"Ann Noninvasive Electrocardiol"},{"issue":"4","key":"pone.0265607.ref004","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1097\/00006842-198907000-00005","article-title":"Responses of the QT interval of the electrocardiogram during emotional stress","volume":"51","author":"M Huang","year":"1989","journal-title":"Psychosom Med"},{"issue":"3","key":"pone.0265607.ref005","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1016\/j.ahj.2007.11.008","article-title":"Apical ballooning syndrome (tako-tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction","volume":"155","author":"A Prasad","year":"2008","journal-title":"Am Heart J"},{"issue":"3","key":"pone.0265607.ref006","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1016\/0301-0511(95)05120-Y","article-title":"Voluntary hyperventilation: the influence of duration and depth on the development of symptoms","volume":"40","author":"H Hornsveld","year":"1995","journal-title":"Biol Psychol"},{"key":"pone.0265607.ref007","doi-asserted-by":"crossref","first-page":"874","DOI":"10.3389\/fpsyg.2017.00874","article-title":"The effect of diaphragmatic breathing on attention, negative affect, and stress in healthy adults","volume":"8","author":"X Ma","year":"2017","journal-title":"Front Psychol"},{"key":"pone.0265607.ref008","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1161\/01.CIR.93.5.1043","article-title":"Heart rate variability: standards of measurement, physiological interpretation, and clinical use","volume":"93","author":"Task Force of the European Society of Cardiology the North American Society of Pacing Electrophysiology","year":"1996","journal-title":"Circulation"},{"issue":"7","key":"pone.0265607.ref009","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.1016\/j.hrthm.2008.03.037","article-title":"Accurate electrocardiographic assessment of the QT interval: teach the tangent","volume":"5","author":"P Postema","year":"2008","journal-title":"Heart Rhythm"},{"issue":"5","key":"pone.0265607.ref010","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1097\/00000658-196211000-00008","article-title":"Pattern of biochemical response to acute change in pCO2","volume":"156","author":"M Andersen","year":"1962","journal-title":"Ann Surg"},{"issue":"4","key":"pone.0265607.ref011","doi-asserted-by":"crossref","first-page":"e93697","DOI":"10.1371\/journal.pone.0093697","article-title":"No myocardial vulnerability to mental stress in takotsubo stress cardiomyopathy","volume":"9","author":"O Collste","year":"2014","journal-title":"PLoS One"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0265607","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,23]],"date-time":"2022-03-23T17:32:59Z","timestamp":1648056779000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0265607"}},"subtitle":[],"editor":[{"given":"Chim C.","family":"Lang","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2022,3,23]]},"references-count":11,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,3,23]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0265607","relation":{},"ISSN":["1932-6203"],"issn-type":[{"type":"electronic","value":"1932-6203"}],"subject":[],"published":{"date-parts":[[2022,3,23]]}}}