Background: Several cardiovascular events, including acute myocardial infarction (AMI), show well-defined temporal patterns in their occurrence throughout the year and the day. The aim of this study was to verify whether Tako-tsubo Cardiomyopathy (TTC) could exhibit significant chronobiological patterns of onset. Methods: Data from 90 consecutive patients with TTC admitted between January 2002 and December 2007 to the coronary care unit of 7 Italian referral cardiac centres were analyzed. All patients were enrolled according to the Mayo Clinic diagnostic criteria. Clinical variables were recorded on a standardized form that included information on patient demographics (sex, age, date and time of onset), signs and symptoms at the event, medical history, trigger events, electrocardiographic ST-segment changes at admission, clinical observations during hospitalization, T troponin level peak, and imaging studies. Day of symptom onset was categorised both into 12 1-month intervals and 4 3-month intervals for seasonal analysis, and 4 6-hour intervals for circadian analysis. The distribution of symptom onset was tested for uniformity by  test for goodness of fit and partial Fourier series. Results: From the overall population, 2 and 11 cases were excluded from the seasonal analysis and circadian analysis, respectively (the final group included 88 and 79 cases, respectively). The mean age of the entire study was 64.4 ± 11.4 years (range 41 to 85 years). The onset of TTC differed as a function of season (p<0.001), with the peak in July and the nadir in March. Events were most frequent in summer (n= 51, 57.9%) and least so in autumn (n= 10, 11.4%)(p < 0.001). Chronobiological analysis identified a significant annual rhythmic pattern in TTC, with the peak in late July (p= 0.016). TTC was most frequent in the morning (n= 32, 40.5%) and least so in night (n= 8, 10.2%) (p = 0.021). Conclusions: This is the first report of significant chronobiological variation in TTTC occurrence, characterized by summer and morning preference in a large cohort of Caucasian patients. Regarding seasonal variation, TTC shows an opposite pattern compared with the major acute cardiovascular diseases, especially AMI, which is characterized by peaks in winter and throughs in summer. The first report of significant chronobiological variation in TTC occurrence, characterized by Summer and morning preference in a large cohort of caucasian patients.

Chronobiological patterns of onset of tako-tsubo cardiomyopathy. A multicenter Italian study

MANFREDINI, Roberto
2009

Abstract

Background: Several cardiovascular events, including acute myocardial infarction (AMI), show well-defined temporal patterns in their occurrence throughout the year and the day. The aim of this study was to verify whether Tako-tsubo Cardiomyopathy (TTC) could exhibit significant chronobiological patterns of onset. Methods: Data from 90 consecutive patients with TTC admitted between January 2002 and December 2007 to the coronary care unit of 7 Italian referral cardiac centres were analyzed. All patients were enrolled according to the Mayo Clinic diagnostic criteria. Clinical variables were recorded on a standardized form that included information on patient demographics (sex, age, date and time of onset), signs and symptoms at the event, medical history, trigger events, electrocardiographic ST-segment changes at admission, clinical observations during hospitalization, T troponin level peak, and imaging studies. Day of symptom onset was categorised both into 12 1-month intervals and 4 3-month intervals for seasonal analysis, and 4 6-hour intervals for circadian analysis. The distribution of symptom onset was tested for uniformity by  test for goodness of fit and partial Fourier series. Results: From the overall population, 2 and 11 cases were excluded from the seasonal analysis and circadian analysis, respectively (the final group included 88 and 79 cases, respectively). The mean age of the entire study was 64.4 ± 11.4 years (range 41 to 85 years). The onset of TTC differed as a function of season (p<0.001), with the peak in July and the nadir in March. Events were most frequent in summer (n= 51, 57.9%) and least so in autumn (n= 10, 11.4%)(p < 0.001). Chronobiological analysis identified a significant annual rhythmic pattern in TTC, with the peak in late July (p= 0.016). TTC was most frequent in the morning (n= 32, 40.5%) and least so in night (n= 8, 10.2%) (p = 0.021). Conclusions: This is the first report of significant chronobiological variation in TTTC occurrence, characterized by summer and morning preference in a large cohort of Caucasian patients. Regarding seasonal variation, TTC shows an opposite pattern compared with the major acute cardiovascular diseases, especially AMI, which is characterized by peaks in winter and throughs in summer. The first report of significant chronobiological variation in TTC occurrence, characterized by Summer and morning preference in a large cohort of caucasian patients.
2009
Citro, R; Previtali, M; Bovelli, D; Vriz, O; Astarita, C; Patella, M. M.; Provenza, G; Armentano, C; Ciampi, Q; Gregorio, G; Piepoli, M; Bossone, E; Manfredini, Roberto
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11392/535227
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