Doctors may have discovered the secret to mending a broken heart in a world-first clinical trial.
Hundreds of thousands of people worldwide are living with takotsubo cardiomyopathy, known as broken heart syndrome, which causes the heart muscle to change shape and suddenly weaken. It is usually triggered by severe emotional or physical stress, such as losing a loved one.
Patients may experience symptoms similar to a heart attack and face twice the risk of dying early compared with the general population. Some experience heart failure, resulting in debilitating symptoms such as fatigue, as well as a shorter life expectancy. There is no cure.
But now, doctors may have the answer. The world’s first randomised controlled trial for broken heart syndrome has found that 12 weeks of tailored cognitive behavioural therapy, or a heart recovery exercise programme involving swimming, cycling and aerobics, helped patients’ hearts recover.
Details of the breakthrough were revealed at the European Society of Cardiology annual congress in Madrid, the world’s largest heart conference.
Dr David Gamble, a clinical lecturer in cardiology at the University of Aberdeen, who presented the research, said: “In takotsubo syndrome, there are serious effects on the heart, which may not return to normal. We know that patients can be affected for the rest of their lives and that their long-term heart health is similar to people who have survived a heart attack.”
The trial data highlighted the importance of “the brain-heart axis”, Gamble said.
“It shows that cognitive behavioural therapy or exercise could help patients along the road to recovery. Both are very cost-effective interventions, and we hope that further studies could lead to them being used to help this underserved group.”
The study involved 76 patients with takotsubo syndrome, 91% of whom were women and the average age was 66. Patients were randomly assigned to receive CBT, the exercise programme, or standard care. All received all other care and treatment recommended by their cardiologist.
The CBT group had 12 one-to-one weekly sessions, adapted specifically to their condition by the researchers, as well as daily support if needed.
The exercise group went through a 12-week exercise course, which included cycling machines, treadmills, aerobics and swimming, gradually increasing in number of sessions and intensity each week.
Researchers used a sophisticated imaging technique called 31Pmagnetic resonance spectroscopy, which allowed them to study how patients’ hearts were producing, storing and using energy. In the CBT and exercise groups, there was a significant increase in the amount of fuel available to patients’ hearts to allow them to pump, which was not seen in people who had usual care.
The average distance that patients that had CBT could walk in six minutes increased from 402 metres to 458 metres. People who completed the exercise programme were able to walk an average of 528 metres in six minutes, compared with 457 metres at the start.
There was also an increase in patients’ VO2 max – their body’s maximum oxygen consumption at peak exercise – of 15% in the CBT group and 18% in the exercise group. Increases in walking distance and VO2 max are signs of improvement in health.
The findings suggest the treatments could produce long-term benefits such as reducing symptoms and the risk of dying for those with broken heart syndrome, experts said.
Dr Sonya Babu-Narayan, a clinical director at the British Heart Foundation, which funded the trial, said: “Takotsubo syndrome can be a devastating condition that can affect you at a really vulnerable time if triggered by a major life event.
“People may not be as surprised that an exercise programme helped heart patients, but it is intriguing that this study also showed that cognitive behavioural therapy improved heart function and patients’ fitness. More research is needed to find out whether these approaches improve survival or symptoms over the long term.”