Abstract 4005: Morning Preference In The Onset of Tako-Tsubo Cardiomyopathy
Background: Aim of this study is to assess the circadian variation in the occurrence of Tako-tsubo cardiomyopathy(TTC).
Methods: We evaluated 78 consecutive pts (76 F, median age 61 yy) with TTC occurring between 2002 and 2008 at the Tako-Tsubo Cardiomyopathy Italian Network (TIN) Centers. All pts fulfilled the following diagnostic criteria for TTC:
transient akinesia/diskinesia beyond a single major coronary artery vascular distribution;
no angiographic evidence of significant coronary artery disease;
new electrocardiographic changes;
absence of intracranial bleeding, pheochromocitoma, myocarditis or hypertrophic cardiomyopathy.
The time of symptom onset during day was categorized into four 6-hour intervals (night: 00:00 – 06:00; morning: 06:00 –12:00; afternoon: 12:00 –18:00; evening: 18:00 –24:00) for circadian analysis. Information on timing of the event that allowed categorization in to 1 of the 4 groups was available in 70 of 78 cases (90%). The distribution was tested for uniformity by the χ2 test goodness of fit.
Results: A circadian pattern, characterized by a significant peak in the morning (χ2=13,38, p=0.004), was found in patents with TTC (figure⇓). This pattern persisted even after adjustment according to a worst-case scenario in which untimed cases were arbitrarily assigned equally to each period according to the null amplitude hypothesis.
Conclusions: Our data indicate a morning prevalence in the onset of TTC similar to other cardiovascular conditions and might be related to the circadian catecholamine activity.