Emotional Dysregulation and Autonomic Dysfunction in Takotsubo Cardiomyopathy Patients

Takotsubo cardiomyopathy (TCM), a disorder that can occur after stress, happens mainly in postmenopausal women. TCM is connected to physical issues, as well as mental and emotional issues. Still, the impact of these factors on the outcome of patient care remains unclear. The purpose of this study is to investigate the relationship between emotional control issues and various autonomic symptoms observed in patients with TCM.

A cross-sectional study was conducted among 385 patients across multiple hospitals in Pakistan, utilizing standardized protocols. Sample size (n = 385) was estimated using a standard prevalence-based formula (95% CI, 5% margin of error). To collect data on emotional dysregulation, participants were administered the Difficulties in Emotion Regulation Scale (DERS), and autonomic symptoms were assessed using the Composite Autonomic Symptom Score (COMPASS-31). Psychological distress was evaluated using the Hospital Anxiety and Depression Scale (HADS). Both scales were validated and reliable. The data were analyzed statistically using Pearson's correlation, Analysis of Covariance (ANCOVA), and multiple linear regression using SPSS. Data was collected between January and April of 2025. Statistical analysis included Pearson's correlation, ANCOVA, and multiple linear regression while controlling for psychiatric history, medication use, time since last episode, and HADS scores. Model assumptions were verified. Missing data were handled via pairwise deletion. Effect sizes and 95% confidence intervals were reported alongside p-values.

Emotional dysregulation was positively associated with autonomic symptoms (r = 0.283, 95% CI (0.198-0.365), p < 0.001). ANCOVA revealed significant main effects of medication use (F (3,367) = 5.30, p = 0.001, partial η² = 0.014) and time since the last TCM episode (F(3,367) = 4.12, p = 0.006, partial η² = 0.001), as well as their interaction (F(9,367) = 3.26, p = 0.001, partial η² = 0.008) on autonomic symptom scores, with post-hoc comparisons indicating specific group differences. Multiple linear regression showed that DERS scores (B = 0.231, 95% CI (0.153-0.309), β = 0.284, p < 0.001) and HADS scores (B = 0.595, 95% CI (0.391-0.799), β = 0.281, p < 0.001) were significant predictors of COMPASS-31 scores, with the model explaining 41.3% of variance (adjusted R² = 0.413).

Emotional dysregulation is strongly associated with autonomic dysfunction in TCM patients, even after adjusting for anxiety, depression, and clinical variables. These findings underscore the importance of integrating psychological assessment and emotion-focused interventions into cardiac care. Given the cross-sectional design and region-specific sample, causal inference and generalizability remain limited. Routine mental health screening and early interventions may improve recovery and reduce recurrence.