Renin-Angiotensin and Endothelin Systems in Patients post Takotsubo Cardiomyopathy

Hilal Khan*, Amelia Rudd, David T Gamble, Alice M Mezincescu, Lesley Cheyne, Graham Horgan, Neeraj Dhaun, David E Newby, Dana K Dawson

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

BACKGROUND: We investigate if renin-angiotensin and endothelin-1 response pathways follow the same pattern of recovery as left ventricular ejection fraction in patients with takotsubo cardiomyopathy. METHODS AND RESULTS: Ninety patients with takotsubo cardiomyopathy (n=30 in each of “acute,” “convalescent” [3–5 months] and “recovered” [>1 year] groups) who were on minimal or no medication and were free of any significant cardiac/metabolic comorbidities, and 30 controls were studied. Serum concentrations of renin, angiotensin-converting enzyme, angiotensin II, big endothelin-1, endothelin-1 were measured using commercially available ELISA, and B-type natriuretic peptide was measured using an immunoassay. Mean left ventricular ejection fraction was <40% during the acute phase in all groups, but recovered to 63% in convalescent and 64% in the recovered groups, respectively. Serum renin concentrations remain persistently elevated after a episode of takotsubo cardiomyopathy (P=0.03 versus controls). Angiotensin converting enzyme levels are significantly depressed during the acute phase compared with convalescent (P=0.004), recovered takotsubo cardiomyopathy (P=0.02) or controls (P=0.03). Angiotensin II is increased in patients with takotsubo cardiomyopathy (P<0.001 versus controls) remaining persistently elevated in the chronically recovered group alone (P=0.03 versus controls). Big endothelin-1 levels are unchanged, but endothelin-1 is significantly lower after takotsubo cardiomyopathy compared with controls (P=0.03). CONCLUSIONS: Despite “normalization” of the left ventricular ejection fraction, there is long-term maladaptive activation of renin-angiotensin system in patients with takotsubo cardiomyopathy.

Original languageEnglish
Article numbere025989
JournalJournal of the American Heart Association
Issue number14
Publication statusPublished - 22 Jul 2022

Keywords / Materials (for Non-textual outputs)

  • angiotensin
  • cardiomyopathy
  • endothelin
  • renin
  • takotsubo


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