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Guido Parodi, MD, PhD; Benedetta Bellandi, MD; David Antoniucci, MD; for the Tuscany Registry of Tako-Tsubo Cardiomyopathy
Author and Funding Information

From the Division of Cardiology, Careggi Hospital.

Correspondence to: Guido Parodi, MD, PhD, Division of Cardiology, Careggi Hospital, Viale Morgagni 85, 50134 Florence, Italy; e-mail: parodiguido@gmail.com


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(4):1101-1102. doi:10.1378/chest.11-1235
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To the Editor:

We thank Drs Manfredini and Bossone for their interest for our recent article.1 As suggested, we reviewed our data in order to verify potential temporal patterns of tako-tsubo cardiomyopathy (TTC) onset in the study population. According to a previous report,2 in 116 patients with TTC enrolled during a 6-year period, the day of symptom onset was categorized into both 12 1-month intervals (from January to December) and four 3-month intervals (winter, spring, summer, autumn). Moreover, we classified the day of onset as weekend (Saturday and Sunday) or workweek day. The distribution of symptom onset was tested for uniformity in the overall population by the χ2 test for goodness of fit. Significance levels were set at P < .05. Figure 1 shows the results of the analyses performed. Despite the number of TTC diagnoses that were slightly higher during the spring and summer compared to winter and autumn, the onset of TTC did not significantly differ as a function of season (Fig 1A). Similarly, there was no significant difference regarding the observed month (Fig 1B) and the observed weekday (Fig 1C) of symptom onset compared with the expected month or day of onset.

Figure Jump LinkFigure 1. Number of tako-tsubo cardiomyopathy diagnoses. A, According to season. B, According to month. C, According to weekday.Grahic Jump Location

A history of an antecedent stressful event, emotional or physical, has been described in the majority of patients with TTC,1,3,4 even when the specific mechanisms relating the stressful event to the left ventricular dysfunction are far from fully elucidated. Different stressful trigger events were identified in our study population, such as confrontations and arguments with friends, relatives, or neighbors; unexpected death of a close relative; receipt of a negative medical diagnosis; fear of invasive medical procedures; devastating financial losses; and burglary. Given the limited data available, we are not able to exclude the possibility of a seasonal variability of the susceptibility of predisposed patients to TTC development (ie, when the patients are subjected to proper stressful trigger events). However, TTC onset time frequently depends on a stressful trigger event occurrence that cannot be anticipated or predicted because, unfortunately, it occurs randomly. Different patterns of trigger event occurrence times between the different enrolled study populations may at least in part explain the reason why a pattern of summer occurance of TTC onset was not confirmed in our cohort.

Parodi G, Bellandi B, Del Pace S, et al; for the Tuscany Registry of Tako-Tsubo Cardiomyopathy for the Tuscany Registry of Tako-Tsubo Cardiomyopathy Natural history of tako-tsubo cardiomyopathy. Chest. 2011;1394:887-892 [CrossRef] [PubMed]
 
Citro R, Previtali M, Bovelli D, et al. Chronobiological patterns of onset of Tako-Tsubo cardiomyopathy: a multicenter Italian study. J Am Coll Cardiol. 2009;542:180-181 [CrossRef] [PubMed]
 
Parodi G, Del Pace S, Carrabba N, et al. Incidence, clinical findings, and outcome of women with left ventricular apical ballooning syndrome. Am J Cardiol. 2007;992:182-185 [CrossRef] [PubMed]
 
Watanabe H, Kodama M, Okura Y, et al. Impact of earthquakes on Takotsubo cardiomyopathy. JAMA. 2005;2943:305-307 [CrossRef] [PubMed]
 

Figures

Figure Jump LinkFigure 1. Number of tako-tsubo cardiomyopathy diagnoses. A, According to season. B, According to month. C, According to weekday.Grahic Jump Location

Tables

References

Parodi G, Bellandi B, Del Pace S, et al; for the Tuscany Registry of Tako-Tsubo Cardiomyopathy for the Tuscany Registry of Tako-Tsubo Cardiomyopathy Natural history of tako-tsubo cardiomyopathy. Chest. 2011;1394:887-892 [CrossRef] [PubMed]
 
Citro R, Previtali M, Bovelli D, et al. Chronobiological patterns of onset of Tako-Tsubo cardiomyopathy: a multicenter Italian study. J Am Coll Cardiol. 2009;542:180-181 [CrossRef] [PubMed]
 
Parodi G, Del Pace S, Carrabba N, et al. Incidence, clinical findings, and outcome of women with left ventricular apical ballooning syndrome. Am J Cardiol. 2007;992:182-185 [CrossRef] [PubMed]
 
Watanabe H, Kodama M, Okura Y, et al. Impact of earthquakes on Takotsubo cardiomyopathy. JAMA. 2005;2943:305-307 [CrossRef] [PubMed]
 
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