Locus of control and stress management strategies in women with takotsubo cardiomyopathy.

The aetiology of takotsubo cardiomyopathy (TTC) is still poorlyunderstood. The most established theory of catecholamine-mediatedmyocardial stunning being provoked by a stressful event is supportedby supraphysiological levels of plasma catecholamines in TTC patients[1]. TTC predominantly occurs in postmenopausal women, and severalstudies suggest a predisposing role of psychiatric or personality traitsin its pathogenesis [2,3].In our recent study, female TTC patients were screened in detail forpsychosocialattributes,butourfindingslendsupportforneithernotice-able psychiatric or personality characteristics nor for an increasedoccurrence of social or work hassles. However, TTC patients showed ablunted cortisol stress response (CSR) compared with cardiac-healthycontrols and high incidences of stressful or traumatic life-events com-pared with healthy controls and non-ST-segment elevation myocardialinfarction (NSTEMI) patients [4].It issuggested thatcertainpersonalitytraits,suchaslocusof control(LOC), largely determine how people cope with stress. Internal LOCrefers to the conviction that outcomes of live events are determinedby one's own behaviour and choices, and is associated with a more ac-tive search for solutions to reduce stress. To the contrary, external LOCimpliesthatoutcomeisdeterminedbyluck,chance,orpowerfulothers.It is associated with unfavourable stress management strategies, leadsto higher stress levels, and might predispose to somatic illness [5].To our knowledge, LOC has not been investigated in TTC patients sofar, and only the research from Hefner and colleagues focuses on stressmanagement in these patients. In their retrospective study [6], the re-searchers compared 31 female TTC patients with 104 healthy womenfrom a normative control sample of the stress-coping questionnaire(SVF-120) and found TTC patients to use some positive strategies,such as deemphasising, less often than controls. In their second paper[7], the authors did not report differences in stress management whenthese TTC patients were compared with 30 females with a history ofacute coronary syndrome (ACS).The present hypothesis-generating study aims to identify internaland external LOC as a possible predisposing personality trait and its re-lationship to stress management in TTC patients for the first time, andcontrasts the results to those of NSTEMI patients and healthy controls.Data were collected from 19 female TTC patients diagnosed atKerckhoff Heart and Thorax Center, Bad Nauheim, Germany. Twentywomen with a history of NSTEMI and 20 cardiac-healthy female volun-teers served as controls. The groups were matched by age (mean age60.5 ± 9.2), and the TTC and NSTEMI patients were additionallymatched by their index event date in relation to study inclusion(mean months 18.4 ± 8.5). All participants gave written, informedconsent and have recently attended our previous study. For extensiveinformationaboutmethodological,clinicalandsociodemographicchar-acteristicspleaserefertothispublication[4].Thelocalethicscommitteeapproved the study.We used the German IPC questionnaire [8] to determine internal(I-Scale) and two dimensions of external LOC (P-scale = powerfulothers, C-scale = chance) which measure one's belief in ‘who’ has thecontroland‘howmuch’controlonehasoverone'slife.Theshortversionof the stress-coping questionnaire (SVF-78, [9]) investigates stressmanagement. It comprises 78 items divided into 13 subscales ofeffective or maladaptive strategies of coping with stress (Table 1).Behaviours defined in the subscales 2–5and8–10 are considered as