9th March 2018, Volume 131 Number 1471

Jen-Li Looi, Mildred Lee, MSc, Corina Grey, Mark Webster, Andrew To, Andrew J Kerr

Several cardiovascular events, including acute myocardial infarction (MI), show well-defined temporal patterns in their occurrence throughout the year, which is characterised by a peak in winter and a trough in…

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Takotsubo syndrome, TS (also known as broken heart syndrome) mimics the presentation of a heart attack. Heart attack shows well-defined temporal patterns in its occurrence throughout the year, which is characterised by a peak in winter and a trough in summer. Our study is the first study to date investigating the seasonal patterns of presentation of TS and heart attack in the Southern Hemisphere. We have demonstrated that the onset of TS differed as a function of season, with the events most frequent in summer and least so in winter. In contrast, incidence of heart attack was highest in winter and lowest in summer. The reasons underlying this seasonal variation observed in TS are still unclear and further studies are needed to investigate the potential link between season variation in TS onset and its underlying cause.



The incidence of myocardial infarction (MI) is characterised by seasonal variation, with a winter peak and summer trough. Takotsubo syndrome (TS) mimics MI, but is thought to have a distinct aetiology and may exhibit a reversed pattern of seasonal variation. This study investigated the seasonal variation in the incidence of TS in comparison to MI.


Two hundred and sixty consecutive patients with TS (95% women, median age 66 years) admitted between March 2004 and December 2016 in the Auckland region of New Zealand were identified. The study population was grouped into three-month intervals (seasons) according to the date of admission to analyse for potential seasonal variations in the incidence. The TS cohort was compared with 36,376 patients who presented with acute MI in the Auckland region (40% women, median age 71 years) between March 2004 and December 2016.


The onset of TS differed as a function of season (p=0.02), with the events most frequent in summer (n=77, 30%) and least so in winter (n=46, 18%). In contrast, incidence of MI also varied by season (p=0.0003), with highest events in winter and lowest in summer.


The pattern of seasonal variation in TS is reversed compared with MI, with peaks during summer.

Author Information

Jen-Li Looi, Department of Cardiology, Middlemore Hospital, Auckland; 
Mildred Lee, Department of Cardiology, Middlemore Hospital, Auckland; 
Corina Grey, Section of Epidemiology and Biostatistics, University of Auckland, Auckland;
Mark Webster, Green Lane Cardiovascular Service, Auckland City Hospital, Auckland;
Andrew To, Cardiovascular Division, North Shore Hospital, Takapuna, Auckland; 
Andrew J Kerr, Department of Cardiology, Middlemore Hospital, Auckland.


We thank the Meteorological Service of New Zealand Limited for providing data on the monthly temperature in Auckland region.


Jen-Li Looi, Department of Cardiology, Middlemore Hospital, Private Bag 93311, Otahuhu, Auckland.

Correspondence Email


Competing Interests



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