CE: Tripti; JCM-D-15-00382; Total nos of Pages: 5;
JCM-D-15-00382
Original article
Climatic variables in Takotsubo cardiomyopathy: role of temperature Giuseppina Novoa, Enrica Marianoc, Salvatore Giambancoa, Vito Bonomoa, Girolamo Mannoa, Annalisa Vielec, Salvatore Evolaa, Francesco Giambancob, Pasquale Assennatoa, Salvatore Novoa and Francesco Romeoc Background Recent studies documented a seasonal (summer) and circadian (morning) temporal distribution of takotsubo cardiomyopathy (TTC).
summer. We found an absolute higher frequency of TTC cases with warmer temperatures. TTC cases occurred during warmer temperatures than AMI.
Aim The aim of our study was to investigate whether there is a relationship among season, temperature and the occurrence of TTC. A second aim of our study was the comparison of climatic variables in Takotsubo cardiomyopathy versus acute myocardial infarction (AMI).
Conclusion Our study does not confirm a summer preference for TTC occurrence, as reported by previous studies, even if, compared with AMI, TTC is more frequent in summer. During warmest days, it was recorded the highest incidence of TTC.
Methods We enrolled consecutive patients with TTC in three Italian centres and, for comparison consecutive patients with AMI. The frequency of TTC and AMI patients according to month, season and quartiles of temperature (I quartile: 9.8–15-, II quartile: 15–19-, III quartile: 19–25and IV quartile: 25–38-C) was reported. Climatic variables of TTC and AMI patients were compared.
J Cardiovasc Med 2016, 17:000–000
Results We included in the study 85 patients with TTC and 900 patients with AMI. It was not observed a significant peak in the occurrence of TTC during summer time; however, when compared with AMI, TTC was more frequent in
Introduction Takotsubo cardiomyopathy (TTC), also known as ‘stress cardiomyopathy’ or ‘transient left ventricular apical ballooning syndrome’, is an enigmatic acute cardiac syndrome first described by Japanese authors in 1990,1 and subsequently also recognized in American and European populations.2–4 It is characterized by presenting symptoms and electrocardiographic (ECG) changes mimicking the scenario of an acute myocardial infarction (AMI), reversible left ventricular dysfunction, modest elevation in cardiac troponin and absence of obstructive coronary disease or angiographic evidence of acute plaque rupture.1 The syndrome occurs mainly in women particularly in postmenopausal period, often it is preceded by emotional or physical stress, and usually it has a benign prognosis.5–7 Classically, left ventriculography shows ‘apical ballooning’ pattern, with hyperkinesia of the basal segments, with a shape closely resembling the ceramic Japanese pot (tsubo) used to trap an octopus (tako).8–10 Recently, new variants have been described with different wall motion anomalies of the left ventricle such as ‘midventricular ballooning’ and sparing or hyperkinesia of the basal and apical segments, or an ‘inverted 1558-2027 ß 2016 Italian Federation of Cardiology. All rights reserved.
Keywords: climatic variables, season, Takotsubo cardiomyopathy, temperature a
Division of Cardiology, A.O. U. Policlinico ‘P. Giaccone’, University of Palermo, Division of Cardiology ‘G.F. Ingrassia’ Hospital, Palermo and cDivision of Cardiology, University of Rome Tor Vergata, Rome, Italy b
Correspondence to Giuseppina Novo, MD, Universita` degli Studi di Palermo, U.O.C. di Cardiologia, Palermo, Italy E-mail: [email protected] Received 25 July 2015 Revised 24 December 2015 Accepted 20 January 2016
Takotsubo’ pattern with akinesia of the basal portions and hyperkinesia of the apex.11,12 To date, the pathophysiology of TTC is still unknown, but the hypothesis of a transient direct toxic effect of catecholamines on the myocardium, induced by a stressful event, is the most reliable.13 It remains unclear why the same stressful events do not always induce the syndrome in one patient. Probably a role is played by genetics.14,15 Definition of chronobiological variations of TTC events could help to better understand the pathogenesis of this complex syndrome. In fact, recent studies documented a seasonal (summer) and circadian (morning) temporal distribution of TTC. Aim of our study was to assess seasonal preferences of the occurrence of TTC and their relationship with temperature; the second aim was to compare climatic variables in TTC and AMI.
Methods We enrolled consecutive patients with TTC from three Italian hospitals (Division of Cardiology, ‘P. Giaccone’ Hospital, University of Palermo, Division of Cardiology, ‘G.F. Ingrassia’ Hospital, Palermo, and Division of Cardiology, University of Rome Tor Vergata, Rome) DOI:10.2459/JCM.0000000000000369
© 2016 Italian Federation of Cardiology. Unauthorized reproduction of this article is prohibited.
CE: Tripti; JCM-D-15-00382; Total nos of Pages: 5;
JCM-D-15-00382
2 Journal of Cardiovascular Medicine 2016, Vol 00 No 00
Table 1
Main clinical characteristics of the study population
Age Male sex (%) Hypertensive (%) Smokers (%) Family history (%) Dyslipidaemia (%) Diabetes mellitus (%)
AMI (n ¼ 900)
TTC (n ¼ 85)
P
69.59 13.53 610 (67.7) 703 (78.11) 421 (46.77) 449 (49.88) 493 (54.77) 325 (36.11)
65 13 6 (7) 64 (75) 27 (32) 24 (28.57) 43 (51) 18 (21)
0.008
JCM-D-15-00382
Original article
Climatic variables in Takotsubo cardiomyopathy: role of temperature Giuseppina Novoa, Enrica Marianoc, Salvatore Giambancoa, Vito Bonomoa, Girolamo Mannoa, Annalisa Vielec, Salvatore Evolaa, Francesco Giambancob, Pasquale Assennatoa, Salvatore Novoa and Francesco Romeoc Background Recent studies documented a seasonal (summer) and circadian (morning) temporal distribution of takotsubo cardiomyopathy (TTC).
summer. We found an absolute higher frequency of TTC cases with warmer temperatures. TTC cases occurred during warmer temperatures than AMI.
Aim The aim of our study was to investigate whether there is a relationship among season, temperature and the occurrence of TTC. A second aim of our study was the comparison of climatic variables in Takotsubo cardiomyopathy versus acute myocardial infarction (AMI).
Conclusion Our study does not confirm a summer preference for TTC occurrence, as reported by previous studies, even if, compared with AMI, TTC is more frequent in summer. During warmest days, it was recorded the highest incidence of TTC.
Methods We enrolled consecutive patients with TTC in three Italian centres and, for comparison consecutive patients with AMI. The frequency of TTC and AMI patients according to month, season and quartiles of temperature (I quartile: 9.8–15-, II quartile: 15–19-, III quartile: 19–25and IV quartile: 25–38-C) was reported. Climatic variables of TTC and AMI patients were compared.
J Cardiovasc Med 2016, 17:000–000
Results We included in the study 85 patients with TTC and 900 patients with AMI. It was not observed a significant peak in the occurrence of TTC during summer time; however, when compared with AMI, TTC was more frequent in
Introduction Takotsubo cardiomyopathy (TTC), also known as ‘stress cardiomyopathy’ or ‘transient left ventricular apical ballooning syndrome’, is an enigmatic acute cardiac syndrome first described by Japanese authors in 1990,1 and subsequently also recognized in American and European populations.2–4 It is characterized by presenting symptoms and electrocardiographic (ECG) changes mimicking the scenario of an acute myocardial infarction (AMI), reversible left ventricular dysfunction, modest elevation in cardiac troponin and absence of obstructive coronary disease or angiographic evidence of acute plaque rupture.1 The syndrome occurs mainly in women particularly in postmenopausal period, often it is preceded by emotional or physical stress, and usually it has a benign prognosis.5–7 Classically, left ventriculography shows ‘apical ballooning’ pattern, with hyperkinesia of the basal segments, with a shape closely resembling the ceramic Japanese pot (tsubo) used to trap an octopus (tako).8–10 Recently, new variants have been described with different wall motion anomalies of the left ventricle such as ‘midventricular ballooning’ and sparing or hyperkinesia of the basal and apical segments, or an ‘inverted 1558-2027 ß 2016 Italian Federation of Cardiology. All rights reserved.
Keywords: climatic variables, season, Takotsubo cardiomyopathy, temperature a
Division of Cardiology, A.O. U. Policlinico ‘P. Giaccone’, University of Palermo, Division of Cardiology ‘G.F. Ingrassia’ Hospital, Palermo and cDivision of Cardiology, University of Rome Tor Vergata, Rome, Italy b
Correspondence to Giuseppina Novo, MD, Universita` degli Studi di Palermo, U.O.C. di Cardiologia, Palermo, Italy E-mail: [email protected] Received 25 July 2015 Revised 24 December 2015 Accepted 20 January 2016
Takotsubo’ pattern with akinesia of the basal portions and hyperkinesia of the apex.11,12 To date, the pathophysiology of TTC is still unknown, but the hypothesis of a transient direct toxic effect of catecholamines on the myocardium, induced by a stressful event, is the most reliable.13 It remains unclear why the same stressful events do not always induce the syndrome in one patient. Probably a role is played by genetics.14,15 Definition of chronobiological variations of TTC events could help to better understand the pathogenesis of this complex syndrome. In fact, recent studies documented a seasonal (summer) and circadian (morning) temporal distribution of TTC. Aim of our study was to assess seasonal preferences of the occurrence of TTC and their relationship with temperature; the second aim was to compare climatic variables in TTC and AMI.
Methods We enrolled consecutive patients with TTC from three Italian hospitals (Division of Cardiology, ‘P. Giaccone’ Hospital, University of Palermo, Division of Cardiology, ‘G.F. Ingrassia’ Hospital, Palermo, and Division of Cardiology, University of Rome Tor Vergata, Rome) DOI:10.2459/JCM.0000000000000369
© 2016 Italian Federation of Cardiology. Unauthorized reproduction of this article is prohibited.
CE: Tripti; JCM-D-15-00382; Total nos of Pages: 5;
JCM-D-15-00382
2 Journal of Cardiovascular Medicine 2016, Vol 00 No 00
Table 1
Main clinical characteristics of the study population
Age Male sex (%) Hypertensive (%) Smokers (%) Family history (%) Dyslipidaemia (%) Diabetes mellitus (%)
AMI (n ¼ 900)
TTC (n ¼ 85)
P
69.59 13.53 610 (67.7) 703 (78.11) 421 (46.77) 449 (49.88) 493 (54.77) 325 (36.11)
65 13 6 (7) 64 (75) 27 (32) 24 (28.57) 43 (51) 18 (21)
0.008
