Impact of Chronobiological Variation in Takotsubo Syndrome: Prognosis and Outcome

Abstract

Background: A considerable amount of evidence has shown that acute cardiovascular diseases exhibit specific temporal patterns in their onset.Aim: This study was performed to determine if takotsubo syndrome (TTS) shows chronobiological variations with short and long-term impacts on adverse events.Design: Our institutional database constituted a collective of 114 consecutive TTS patients between 2003 and 2015.Methods: Patients were divided into groups defined by the onset of TTS as per time of the day, day of the week, month and quarter of year.Results: TTS events were most common afternoon and least common in the night, indicating a wave-like pattern (p = 0.001) of manifestation. The occurrence of TTS events was similar among days of the week and weeks of the month. TTS patients diagnosed in the month of November and subsequently in the fourth quarter showed a significantly longer QTc interval. These patients also revealed a significantly lower event-free-survival over a 1-year follow-up. In a multivariate Cox regression analysis, TTS events occurring in the fourth quarter of year (HR 6.8, 95%CI: 1.3–35.9; p = 0.02) proved to be an independent predictor of lower event-free-survival.Conclusions: TTS seems to exhibit temporal preference in its onset, but nevertheless this possibly coincidental result needs to be analyzed in a large multicenter registry.

Hyperthermia as a trigger for Takotsubo syndrome in a rat model

“…Takotsubo syndrome is statistically more likely to occur in summer or early autumn (unlike the winter presentation preference for most cardiac diseases) and is separately associated with higher ambient temperatures ( 16 , 17 ). There has also been an afternoon predominance for TTS presentation compared to night-time ( 18 ) Fever and particularly sepsis have strong associations with Takotsubo syndrome ( 19 ), and high temperature was a predictor of worse outcomes in a series of 421 admissions for the syndrome ( 20 ). Hyperthyroidism, which is associated with raised body temperature, has been observed in a proportion of patients with Takotsubo syndrome ( 21 ).…”