Does the personality trait of neuroticism cause vulnerability for Takotsubo cardiomyopathy? A literature review.

Abstract

Introduction: Takotsubo cardiomyopathy (TTC) is a transient left ventricular apical, medial or basal dysfunction, recovering completely without myocardial injury. It was first clinically described in 1991 by Sato et al. Impact of psychological distress and personality factors remains unclear. The aim of the study was to assess if the personality trait of neuroticism, can increase the vulnerability for TTC. Material and methods: A systematic literature search was performed in MEDLINE in august 2018, using relevant MeSH terms obtained from PubMed. The search was limited to literature in the time period 2007 – 2018. Study designs included clinical studies, comparative studies, interviews, journal articles, randomized control trials, “reviews” and systematic reviews. 206 records were identified through database searching. After screening of abstracts, 88 articles remained. Selected studies were then assessed for their relevance to the thesis and for scientific quality. Results: TTC consists predominantly of postmenopausal women. Presenting symptoms are chest pain and dyspnea. The majority has an emotional stressor combined with a physical or isolated emotional stressor. Anxiety and distress are observed as prominent factors. Though, a correlation between personality type D (PTD) or neuroticism with TTC is incomplete regarding evidence. Most studies underline acute stressful events as a trigger for TTC, while other publications highlight the impact of cumulative stress as more significant. Conclusion: The current literature did not show significant correlations between TTC, depression, PTD and neuroticism. However, anxiety has been proven to be a prominent feature. Studies have identified stressful events immediately preceding the acute event. However, some results indicate that exposure to repeated stressful events may have a more decisive role in onset of TTC. Response to distressing factors depends on personality traits, vulnerability and resilience. Nevertheless, more research is needed regarding correlation between neuroticism and TTC.