Department of Public Health, University of Naples "Federico II", Naples, Italy; Unit of Cardiology, University of Campania "Luigi Vanvitelli", Naples, Italy.
Department of Environmental Sciences and Prevention, University of Ferrara, Ferrara, Italy.
Curr Probl Cardiol. 2024 Nov;49(11):102804. doi: 10.1016/j.cpcardiol.2024.102804. Epub 2024 Aug 18.
Takotsubo syndrome (TTS) might exhibit particular chronobiological patterns in its onset, characterized by variations according to time of the day, day of the week, and month of the year. The aim of this study was to fully explore the temporal patterns (circadian, weekly and seasonal) in the onset of TTS. A systematic review and meta-analysis of literature were conducted for studies (2006-2024) reporting the temporal patterns (circadian, weekly and/or seasonal) in the onset of TTS. Among the 4257 studies retrieved, 20 (including 64,567 subjects) fulfilled all eligibility criteria. Data were aggregated used random effects model as pooled risk ratio and the attributable risk (AR). The proportion analysis (including 8 studies; n=853) showed a decreasing pattern of the pooled rates of TTS shifting from the morning to the night (pooled TTS rates: 34.0%; 32.1%; 21.7%; 12.7% in the morning, afternoon, evening and night, respectively). The same pattern was observed stratifying by type of preceding stressful factor or event, considering physical stressors (pooled rates in the morning and night: 37.6% and 9.8%, respectively), and also in case no event could be identified. The pooled rates of TTS onset peaked on Monday and Tuesday (17.3% and 18.4% respectively), then declined during the week, reaching the lowest rates on Friday and Saturday (10.6% and 10.8%, respectively), with no sex differences. TTS onset reached the highest values on summer, and the lowest in winter (27.9% versus 21.7% in summer and winter, respectively). The TTS morning peak based analyses (∼33% of all the registered events) account for a RR of 1.46 (95% CI: 1.38-1.54), the week-based for a RR of 1.26 (1.16-1.35), the season-based for a RR of 1.04 (1.04-1.05). TTS onset exhibits specific chronobiological patterns, characterized by a peak during the morning hours, and on Monday and Tuesday. Differing from other cardiovascular emergencies TTS was more frequent during summer. Further studies are needed to fully understand the underlying pathophysiological mechanisms in order to tailor relative management and preventive strategies.
心尖球囊综合征（TTS）的发作可能具有特定的时间生物学模式，其特征是根据一天中的时间、一周中的天数和一年中的月份而变化。本研究的目的是全面探讨 TTS 发作的时间模式（昼夜、周和季节）。对 2006 年至 2024 年期间报告 TTS 发作的时间模式（昼夜、周和/或季节）的文献进行了系统评价和荟萃分析。在检索到的 4257 项研究中，有 20 项（包括 64567 例患者）符合所有入选标准。使用随机效应模型汇总数据，以 pooled risk ratio 和 attributable risk (AR) 表示。比例分析（包括 8 项研究；n=853）显示，TTS 的 pooled 发生率从早晨到晚上呈下降趋势（pooled TTS 发生率：早晨、下午、晚上和晚上分别为 34.0%、32.1%、21.7%和 12.7%）。考虑到物理应激源（早晨和晚上的 pooled 发生率分别为 37.6%和 9.8%），或在无法确定事件的情况下，按先前应激因素或事件的类型进行分层，也观察到了相同的模式。TTS 发作的 pooled 发生率在周一和周二达到高峰（分别为 17.3%和 18.4%），然后在一周内下降，周五和周六达到最低（分别为 10.6%和 10.8%），性别差异无统计学意义。TTS 发作的发生率在夏季最高，冬季最低（夏季和冬季分别为 27.9%和 21.7%）。基于 TTS 早晨高峰的分析（约占所有登记事件的 33%）的 RR 为 1.46（95%CI：1.38-1.54），基于周的 RR 为 1.26（1.16-1.35），基于季节的 RR 为 1.04（1.04-1.05）。TTS 发作具有特定的时间生物学模式，其特征是早晨高峰，以及周一和周二高峰。与其他心血管急症不同，TTS 在夏季更为常见。需要进一步研究以充分了解潜在的病理生理机制，以便制定相应的管理和预防策略。
