Temporal patterns in Takotsubo syndrome: the influence of circadian, weekly, monthly and seasonal rhythms on symptom onset

Abstract Background Takotsubo Syndrome (TTS) is an acute, reversible cardiac condition that often mimics myocardial infarction. It is frequently associated with stressors, and emerging evidence suggests circadian, weekly, and seasonal variations in its incidence. This study aimed to examine the temporal patterns in the incidence of TTS, focusing on daily, weekly, and seasonal distributions, and to explore potential biological and environmental influences on its onset. Methods This retrospective analysis examined the temporal distribution of TTS cases from a large, multi-center registry collected between January 2015 and December 2022. Data were analyzed for daily, weekly, monthly, and seasonal incidence patterns. Chi-square tests were used to assess the significance of observed temporal trends. Results TTS incidence peaked in the afternoon and was significantly lower during the evening in contrast to MI incidence that peaked in the morning. There was a marked increase in cases from Monday to Wednesday, with a gradual decline toward the weekend. Seasonally, a significant rise in TTS cases was observed during late summer and early autumn, particularly between August and October. Conclusion The findings suggest that TTS incidence is influenced by both circadian rhythms and external stressors, such as work routines and seasonal factors. Awareness of these patterns can aid in early identification and preventive strategies in at-risk populations.