CORRESPONDENCE: LETTER TO THE EDITOR
Occurrence of Tako-Tsubo Cardiomyopathy and Chronobiological Variation
Nicolas Mansencal, MD*,
Rami El Mahmoud, MD and
Olivier Dubourg, MD
* AP-HP, Hôpital Ambroise Paré, Université de Versailles-Saint Quentin (UVSQ), Service de Cardiologie et des Maladies Vasculaires, Centre de Référence des Maladies Cardiaques Héréditaires, 9 Avenue Charles de Gaulle, Boulogne 92100, France (Email: nicolas.mansencal{at}apr.aphp.fr).
We read with great interest the paper by Citro et al. (1), in which the investigators found significant chronobiological variations in Tako-Tsubo cardiomyopathy (TTC) occurrence. In their large series, TTC was most frequently found in summer and in the morning.
We reviewed our cases of TTC from January 2000 to December 2008. We classified our patients (month, season, and time of symptom) according to the method of Citro et al. (1), and we surprisingly found differing results. In our series of patients (n = 51 [50 women], mean age 71 ± 11 years), the peak of occurrence was April, whereas only 12% of TTC occurred in summer (Fig. 1). The morning and the afternoon were the most frequent periods of onset of TTC. However, in our series, the onset of the disease may differ according to the stressful event: all TTC after surgery (n = 6) occurred in the morning, whereas aggression or robbery (n = 9) were found whatever the time of day.
TTC is defined as transient left ventricular dysfunction triggered by stress, with left ventricular regional wall motion abnormalities extending beyond a single epicardial coronary distribution and without any coronary lesion (2,3). This new cardiomyopathy preferentially occurred after an emotional or stressful event, and catecholamine excess remains the main hypothesis (2,4–6). Different types of stress are involved in the process of TTC, leading to differing results in TTC studies.
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1. 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;54:180-181.[Free Full Text]2. Prasad A, Lerman A, Rihal CS. Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction Am Heart J 2008;155:408-417.[CrossRef][Web of Science][Medline] 3. Mansencal N, Abbou N, Pillière R, El Mahmoud R, Farcot JC, Dubourg O. Usefulness of two-dimensional speckle tracking echocardiography for assessment of Tako-Tsubo cardiomyopathy Am J Cardiol 2009;103:1020-1024.[CrossRef][Web of Science][Medline] 4. Wittstein IS, Thiemann DR, Lima JA, et al. Neurohumoral features of myocardial stunning due to sudden emotional stress N Engl J Med 2005;352:539-548.[CrossRef][Web of Science][Medline] 5. Elliott P, Andersson B, Arbustini E, et al. Classification of the cardiomyopathies: a position statement from the European society of cardiology working group on myocardial and pericardial diseases Eur Heart J 2008;29:270-276.[Abstract/Free Full Text] 6. Abraham J, Mudd JO, Kapur N, Klein K, Champion HC, Wittstein IS. Stress cardiomyopathy after intravenous administration of catecholamines and beta-receptor agonists J Am Coll Cardiol 2009;53:1320-1325.[Abstract/Free Full Text]
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