Chronobiological patterns of onset of Tako-Tsubo cardiomyopathy: a multicenter Italian study

Tako-Tsubo cardiomyopathy (TTC), also called “stress cardiomyopathy” or “transient left ventricular apical ballooning syndrome,” is an acquired cardiomyopathy prevalent in elderly women presenting with a history of emotional or physical stress that mimics the clinical scenario of an AMI (3,4). The aim of this study was to verify whether TTC could exhibit significant chronobiological patterns of onset. We analyzed data from 90 consecutive patients with TTC admitted between January 2002 and December 2007 . The onset of TTC differed as a function of season (p 0.001),with the peak in July and the nadir in March (Fig. 1, upper panel). Events were most frequent in summer (n 51; 57.9%) and least so in autumn (n 10; 11.4%; chi-square 20.113; p 0.001) (Fig. 1,middle panel). Chronobiological analysis identified a significant annual rhythmic pattern in TTC, with the peak in late July, and 95% confidence limits in July and August (MESOR 7.36 1.17; amplitude 6.12 1.66; p 0.016). TTC was most frequent in the morning (n 32; 40.5%) and least so at night (n 8; 10.2%; chi-square 10.303; p 0.021). This is the first report of significant chronobiological variation in TTC occurrence, characterized by summer and morning preference in a large cohort of Caucasian patients.