Investigation of Mechanisms Underlying Takotsubo Syndrome using an Electromechanical Heart Model

Carola Kruthoff1, Jonathan Krauss2, Axel Loewe3
1Karlsruhe Institute of Technology, 2Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), 3Karlsruhe Institute of Technology (KIT)


Abstract

Takotsubo syndrome (TTS) is a reversible form of heart failure typically affecting postmenopausal women after a stressful trigger. It is characterized by a transient ballooning of the left ventricle (LV) during systole and a rightward shift of the pressure-volume-loop (pV loop). The underlying pathophysiology of TTS remains unclear, with hypotheses ranging from a corruption of the Purkinje-muscle junctions (PMJs) or a change in active stress development (Ta) due to sympathetic overdrive. We hypothesized four different mechanisms (A-D) to reproduce ballooning, by dividing the ventricles into an apical and a basal region. For scenario A, we deactivated PMJs in the apical region while preserving conduction and stress development in the myocardium. In scenario B, we 4-chamber slice of scenario D at systole. ab: apico-basal coordinate disabled Ta in the apical region. We doubled Ta in the basal region in scenario C. For scenario D, we combined B and C. We compared all results to an unaltered control simulation. Deactivation of the PMJs resulted in a slightly delayed onset of contraction in the apex without ballooning. There was no change in LV ejection fraction (LVEF) compared to the control simulation. Both scenarios B and D led to a visible ballooning effect, a lower LVEF (B: 36.1%, D: 43.4%) than in the control (56.6%) and a rightward shift of the pV loop. Scenario C, demonstrated a slightly stronger constriction in the basal region compared to the control and almost no change in LVEF (59.7%). According to our findings, a corruption of the PMJs cannot be the sole cause for the TTS phenotype. Hypo-contractility in the apex appears to be the main factor driving apical ballooning, while basal hyper-contractility could be a contributing mechanism. The role of the sympathetic nervous system on Ta warrants exploration in follow-up work.