Hemostatic system in Takotsubo patients at long-term follow-up: A hidden activation?

• Published in: International journal of cardiology Vol. 390; p. 131229
• Main Authors: Amadio, Patrizia, Porro, Benedetta, Cavalca, Viviana, Zarà, Marta, Eligini, Sonia, Sandrini, Leonardo, Werba, José Pablo, Cosentino, Nicola, Olivares, Paolo, Galotta, Arianna, Bonomi, Alice, Tremoli, Elena, Trabattoni, Daniela, Barbieri, Silvia Stella
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.11.2023
• Subjects: BDNF; Coagulation; Fibrinogen; PAI-1; Takotsubo cardiomyopathy; aPTT; PT; BDNF; Coagulation; Takotsubo cardiomyopathy; ThPI; MCE; CFT; CT; MCF; TF; Fibrinogen; ROTEM; PAI-1; MP-TF
• ISSN: 0167-5273; 1874-1754; 1874-1754
• DOI: 10.1016/j.ijcard.2023.131229

Takotsubo cardiomyopathy (TTS) has long been considered a benign condition, despite recurrent events and long-term adverse outcomes are often reported. Endothelial damage, blood hyperviscosity, and platelet activation described in acute phase persist in long-term follow-up; however, TTS pathophysiology is still not fully understood. Here, we explored the hemostatic system at a median of 3.1 years after TTS to uncover additional long-lasting changes in these patients. We assessed hemostatic parameters in women with TTS (n = 23) or coronary artery disease (CAD; n = 31) and in control women (n = 26) age-matched, by thromboelastographic analysis, prothrombin time (PT) and partial thromboplastin time (aPTT) coagulation assays and microparticle exposing Tissue Factor (MP-TF). Functional fibrinogen and fibrin polymerization were analyzed by Clauss method and spectrophotometry, respectively. Platelet reactivity was evaluated by light transmission aggregometry, whereas plasminogen activator inhibitor-1 (PAI-1) and brain-derived neurotrophic factor (BDNF) were measured by ELISA kit. Compared with control subjects, TTS patients exhibit an accelerated clot formation, higher percentage of fibrin polymerization and higher PAI-1 levels. Compared with CAD, TTS patients showed sustained residual platelet activation but decreased functional fibrinogen, fibrin polymerization and MP-TF levels, prolonged aPTT and a marked BDNF increase. The long-term activation of hemostatic system observed in TTS patients compared to control subjects suggests a persistent humoral abnormality that may be related to the propensity for TTS recurrence. The higher residual platelet activity observed in TTS than in CAD patients invites investigation on TTS-tailored antiplatelet therapy potentially needed to prevent TTS adverse outcomes. •Takotsubo syndrome has been recently indicated as a life-threatening condition.•Takotsubo patients exhibit hemostatic activation compared to control subjects.•Takotsubo patients show a residual platelet activation compared to CAD patients.