GRANTS. The Swedish Heart-Lung Foundation has decided to distribute SEK 14 million to 10 research projects in Gothenburg. The research can have important implications for the millions of Swedes who suffer from diseases of the heart or lungs.
One of the major grants from the Swedish Heart-Lung Foundation was awarded to Elmir Omerovic, a cardiologist and Associate Professor in the Department of Molecular and Clinical Medicine at Sahlgrenska Academy’s Institute of Medicine. His project concerns Takotsubo syndrome, which was first reported in Japan in 1991. Elmir diagnosed the first Swedish case in 2005 at Sahlgrenska University Hospital, but in retrospect he realized that he had encountered several patients with this syndrome much earlier.
“The first Swedish patient diagnosed with the syndrome was a person who had been subjected to severe bullying in the workplace,” says Elmir. He adds that prolonged bullying in the workplace can produce a form of stress response often regarded as one of the underlying causes of the syndrome.
Resembles a heart attack
Takotsubo syndrome, which is sometimes also called broken heart syndrome, is a condition triggered by powerful, negative stress that still has no medical explanation. In addition to prolonged stress, acute personal crises, death in the family or serious physical ailments such as cancer, trauma, stroke and asthma attacks can cause Takotsubo syndrome.
Clinically speaking, the syndrome resembles an acute heart attack, and consequently it is not always diagnosed correctly. But there are significant differences between Takotsubo patients and those with acute heart attacks, which means that medication used for the treatment of an acute heart attack can be downright harmful to patients with Takotsubo. In mild cases a short treatment with drugs to prevent a blood clot, or even no treatment at all, is sufficient. Often patients’ personal circumstances are the underlying cause, so it’s important to understand their medical history to provide the right treatment. If the diagnosis and treatment are wrong, the consequences can be fatal.
Through SWEDEHEART, Sweden’s online cardiac registry, we know that more than 50 people in Sweden are afflicted with Takotsubo syndrome every month. Since 2008 the number of cases has increased, which is not just due to increased awareness of the illness.
“At a cardiologist conference a few weeks ago, all those attending raised their hands when I asked if they knew what Takotsubo syndrome is. Ten years ago almost no one did,” says Elmir.
Lower mortality in Region Västra Götaland
He maintains that success in disseminating knowledge about the syndrome and enhanced knowledge of diagnosis and treatment is due to grants received for many years from groups such as the Swedish Heart-Lung Foundation, Swedish Research Council and ALF Västra Götaland as well as to scientific publications and personal contacts.
Through both clinical and experimental studies, Elmir Omerovic and his team have now been able to contribute to concrete improvements in the care of this patient population, and the mortality rate in our region is significantly lower compared with other European countries.
“We have now been able to turn our results into concrete action. Knowledge from our preclinical and clinical research based on data about these patients from SWEDEHEART has been used to develop international guidelines under the European Society of Cardiology.”
Can be a way to protect the heart
Their research is translational, and this provides a greater opportunity to examine patients from many angles, something that is necessary with this complex syndrome.
“Through clinical animal models, studies of people afflicted and in-depth interviews, we have increasingly begun to suspect that the syndrome involves the body’s self-defense mechanism,” Elmir says. “This is an unusual hypothesis that goes a bit against the grain. But maybe the body protects the heart against the more harmful effects of stress hormones in cases of powerful stress responses by developing Takotsubo syndrome. It might be preferable to developing ventricular fibrillation, which untreated will lead to sudden death.”
He thinks these reflections on the phenomenon of “endogenous protection” and self-healing ability are very exciting. Perhaps during the course of the research, more will be learned about the underlying mechanisms, and ultimately new ways of treatment will be developed that protect the heart in case of a regular heart attack or heart failure as well.
The first randomized studies
Although the number of patients diagnosed with Takotsubo syndrome is increasing throughout the world, no randomized clinical trials have been carried out yet.
“What we now want to do is set up the first randomized studies,” Elmir says. “We plan to implement a pragmatic clinical study within the SWEDEHEART platform to test whether a clinical strategy based on cardioprotective and limited administration of anticoagulants reduces mortality and morbidity in Takotsubo patients.”
A distinguishing feature of Takotsubo, and the thing sets the syndrome apart from a regular heart attack, is the way the heart’s ventricles (usually the left one) become enlarged and take on a balloon-like shape, which impairs the heart’s ability to pump blood. Takotsubo’s symptoms resemble an acute heart attack and are manifested as chest pain, elevated levels of the troponin marker of heart damage and an abnormal electrocardiogram. The condition is transient in the vast majority of patients, with the functioning of the heart returning to normal within a few days, resulting in faster recovery for a Takotsubo patient than a heart attack patient. Usually there is no lasting damage to the heart, but a relapse may occur in up to 15 percent of all those afflicted.
Major study on platelet preventive treatment
Of the ten Gothenburg researchers receiving funding in the Swedish Heart-Lung Foundation’s call for research proposals, Anders Jeppsson, professor of thoracic surgery, is receiving the largest grant. He receives SEK 4.5 million for a multi-center project that will investigate the best way to prevent blood clots in patients undergoing coronary artery bypass surgery. It is a national, randomized study comparing double platelet inhibition, in which the patient receives both ticagrelor medication and acetylsalicylic acid, with the most common platelet preventive treatment consisting only of acetylsalicylic acid. The project also recently received more than SEK 7.5 million from the Swedish Research Council.
“With the help of research, the Swedish Heart-Lung Foundation is taking up the fight against the deadliest diseases of all,” Kristina Sparreljung, secretary-general of the Swedish Heart-Lung Foundation, stated in a press release. “Therefore, it gives me great pleasure in connection with Nobel Day to be able to tell you that this year we have appropriated SEK 14 million in support of Gothenburg’s fantastic researchers. It is my hope that we, with the help of our donors, will be able to distribute even more in the future.”
TEXT: SUSANNE LJ WESTERGREN
