Takotsubo syndrome: cognitive behavioural therapy, physical training, and brain function recovery in the BREAKOUT trial

Hilal Khan; David Gamble; Amelia Rudd; Ciprian Dospinescu; Calum Creaney; Graham Horgan; Andrea L Holme; Heather Wilson; David E Newby; Stuart Gray; Rajeev  Krishnadas; Christopher Williams; Gordon Waiter; Dana Dawson

doi:10.1093/eurheartj/ehaf441

Takotsubo syndrome: cognitive behavioural therapy, physical training, and brain function recovery in the BREAKOUT trial

Hilal Khan
, David Gamble
, Amelia Rudd
, Ciprian Dospinescu
, Calum Creaney
, Graham Horgan
, Andrea L Holme
, Heather Wilson
, David E Newby
, Stuart Gray
, Rajeev Krishnadas
, Christopher Williams
, Gordon Waiter
, Dana Dawson^* (Corresponding Author)

^*Corresponding author for this work

University of Edinburgh
University of Edinburgh and British Heart Foundation Centre for Cardiovascular Science
University of Glasgow
Public Health Wales

Research output: Contribution to journal › Article › peer-review

9 Citations (Scopus)

4 Downloads (Pure)

Abstract

Takotsubo syndrome is an acute disease at the interface between the brain and heart, whereby a stressful trigger results in severe decline of cardiac function.1 We have previously shown that acute takotsubo syndrome is accompanied by a strong myocardial and systemic inflammatory process.2 We and others have demonstrated structural and functional brain differences between patients with acute takotsubo syndrome and age- and sex-matched control subjects.3–7 We hypothesized that behavioural modifications such as physical exercise training or cognitive behavioural therapy will improve structural and functional brain recovery patterns (reflected by changes in hippocampal and other brain volumes as well as in functional connectivity) after acute takotsubo cardiomyopathy, relative to current standard care.

Original language	English
Pages (from-to)	4127-4129
Number of pages	3
Journal	European Heart Journal
Volume	46
Issue number	40
Early online date	7 Aug 2025
DOIs	https://doi.org/10.1093/eurheartj/ehaf441
Publication status	Published - 21 Oct 2025

Bibliographical note

Open access via the OUP Agreement

We would like to acknowledge Professor Mark Petrie, consultant cardiologist, Glasgow; Dr Stuart Watkins, consultant cardiologist, Glasgow; Dr David Corcoran, consultant cardiologist, Glasgow; Prof. Stephen Leslie, consultant cardiologist, Inverness; Dr David Carrick, consultant cardiologist, Hairmyres Hospital, Lanarkshire; Professor Chim Lang, consultant cardiologist, Dundee; and Dr Neil Anglim, consultant cardiologist, Dundee, for identifying patients recruited in this study. The authors gratefully acknowledge the BHF Cardiovascular Biomarker Laboratory, University of Edinburgh, for their assistance with this work.

Data Availability Statement

Anonymous participant data is available on reasonable request. These will be reviewed by the Principal Investigator and made available on assessing the merit of each request. Once such a request is approved data can be made available on a secure online data sharing platform after signing of a data access agreement and confidentiality agreement.

Funding

This work was supported by British Heart Foundation project grant no. PG/18/35/33786 and NHS Grampian Charity EA9667/ES868. D.E.N. is supported by the British Heart Foundation (CH/09/002/26360, RG/F/22/110093, RE/24/130012). D.D. is supported by the British Heart Foundation (PG/24/11930, FS/CRTF/23/24508, FS/CRTF/22/24275, PG/22/11117, FS/RTF/20/30009, NH/19/1/34595), National Institute for Health and Care Research (NIHR157523), and Tenovus Scotland (G23.03, G24.07).

Funders	Funder number
British Heart Foundation	PG/18/35/33786, CH/09/002/26360, RG/F/22/110093, RE/24/130012, PG/24/11930, FS/CRTF/23/24508, PG/22/11117, FS/RTF/20/30009, NH/19/1/34595
NHS Grampian	EA9667/ES868
National Institute for Health and Care Research	NIHR157523
Tenovus Scotland	G23.03, G24.07

Keywords

Takotsubo syndrome
Brain functional magnetic resonance imaging
Exercise
Cognitive behavioural therapy
Behavioural modification

Access to Document

10.1093/eurheartj/ehaf441Licence: CC BY

Khan_etal_EHJ_Takotsubo_syndrome_cognitive_VOR
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
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Cite this

Khan, H., Gamble, D., Rudd, A., Dospinescu, C., Creaney, C., Horgan, G., Holme, A. L., Wilson, H., Newby, D. E., Gray, S., Krishnadas, R., Williams, C., Waiter, G., & Dawson, D. (2025). Takotsubo syndrome: cognitive behavioural therapy, physical training, and brain function recovery in the BREAKOUT trial. European Heart Journal, 46(40), 4127-4129. https://doi.org/10.1093/eurheartj/ehaf441

Khan, H, Gamble, D, Rudd, A, Dospinescu, C, Creaney, C, Horgan, G, Holme, AL, Wilson, H, Newby, DE, Gray, S, Krishnadas, R, Williams, C, Waiter, G & Dawson, D 2025, 'Takotsubo syndrome: cognitive behavioural therapy, physical training, and brain function recovery in the BREAKOUT trial', European Heart Journal, vol. 46, no. 40, pp. 4127-4129. https://doi.org/10.1093/eurheartj/ehaf441

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abstract = "Takotsubo syndrome is an acute disease at the interface between the brain and heart, whereby a stressful trigger results in severe decline of cardiac function.1 We have previously shown that acute takotsubo syndrome is accompanied by a strong myocardial and systemic inflammatory process.2 We and others have demonstrated structural and functional brain differences between patients with acute takotsubo syndrome and age- and sex-matched control subjects.3{\textendash}7 We hypothesized that behavioural modifications such as physical exercise training or cognitive behavioural therapy will improve structural and functional brain recovery patterns (reflected by changes in hippocampal and other brain volumes as well as in functional connectivity) after acute takotsubo cardiomyopathy, relative to current standard care.",

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AU - Creaney, Calum

AU - Horgan, Graham

AU - Holme, Andrea L

AU - Wilson, Heather

AU - Newby, David E

AU - Gray, Stuart

AU - Krishnadas, Rajeev

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AU - Waiter, Gordon

AU - Dawson, Dana

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Takotsubo syndrome: cognitive behavioural therapy, physical training, and brain function recovery in the BREAKOUT trial

Abstract

Bibliographical note

Data Availability Statement

Funding

Keywords

Access to Document

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