A Temporal High-Risk Frame for Occurrence of Tako-Tsubo Cardiomyopathy




Sharkey et al analyzed a cohort of 186 consecutive patients with takotsubo cardiomyopathy (TTC) and 2,975 patients with ST-segment elevation myocardial infarction and identified a circadian pattern with a peak in the early afternoon hours (from 12 to 4 pm ). They analyzed this cohort also by day of the week and month of the year and found a uniform distribution throughout the week and the year, although events were most common in December and on Tuesdays.


These data do not fully agree with previous reports. With regard to circadian distribution, in their recent systematic review, Bossone et al identified 4 studies addressing this topic. Only an Italian cohort by Citro et al found an evident morning distribution (6 am to 12 pm ). Other studies, performed in limited populations, have reported statistically nonsignificant diurnal distributions. Analyses by day of the week have also produced variable findings. Manfredini et al observed a greater frequency of TTC onset on Mondays in their multicenter cohort of patients in Italy, but Parodi et al did not replicate these results in another Italian population. Finally, the greater summer occurrence of TTC onset found by Manfredini et al in Italy (n = 112), Regnante et al in the Rhode Island Takotsubo Cardiomyopathy Registry (n = 70), and Hertting et al in Germany (n = 32) recently received important support from Deshmukh et al, who found in >6,800 patients in the United States a peak in July (and a nadir in January).


Sharkey et al also confirmed the greater morning occurrence of ST-segment elevation myocardial infarction onset, but they found a uniform distribution of occurrence during the week and the year. Although the former observation provides further confirmation for the topic, the latter is in contrast with the large amount of data indicating greater frequency on Mondays and during winter for the onset of myocardial infarction.


Studies in different countries with different environments, performed using different methods for collecting and analyzing temporal data, may at least in part explain such different results. For now, at least the greater summer frequency of TTC is supported by convincing data. However, because of the nonuniform findings of recent studies, we recently stated that time of onset does not represent a useful tool for diagnosing TTC. Nevertheless, the demonstration of temporal windows at enhanced risk for the occurrence of TTC, as for acute cardiovascular diseases, cannot represent a secondary concern, because of potential implications for possible prevention and temporized treatment. More evidence is needed, and worldwide clinical studies on TTC should include also data on temporal (i.e., circadian, weekly, or seasonal) patterns of occurrence.


References



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Dec 7, 2016 | Posted by in CARDIOLOGY | Comments Off on A Temporal High-Risk Frame for Occurrence of Tako-Tsubo Cardiomyopathy

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