P809Effects of air temperature and pollution on Takotsubo cardiomyopathy

Abstract

Abstract Background Air temperature and pollution are the main environmental factors influencing cardiovascular mortality and risk of myocardial infarction. Takotsubo cardiomyopathy (TCM) is a transient and reversible myocardial dysfunction whose cause and pathogenesis remain incompletely understood, but which, unlike acute coronary syndrome, does not involve obstructive coronary atherosclerosis or plaque rupture. The potential role of the environment on the risk to develop TCM remains poorly defined. Methods We aimed to study the effects of air temperature, particulate matter (PM) and gaseous pollutants (NO2 and ozone) on hospitalization rate forTCM. All hospitalizations in Belgian Hospitals for TCM (ICD 9:429.83) from 2009 to 2014 were recorded. National air pollution parameters were extracted from the Belgian Environment Agency database. A time-stratified and temperature-matched (except for air temperature effect) case-crossover analysis of the risk of TCM was performed. The main analysis focused on 0-day lag time (lag 0) between exposure and TCM; a lag structure analysis up to lag 4 was also performed. Results 1840 patients were included in the study (88% women). More TCM occurred during the warm compared to the cold period (fig.1; chi2p value <0.05). At lag 0, each decrease of 1°C in ambient air temperature increased the odds ratio (OR) of TCM of 1.020 (IC 95%: 1.003–1.035). This effect was more pronounced during the cold period and at lag 4 (RR 1.060; IC 95%: 1.031–1.091). Conversely, during the warm period and between lag 1 and 4, an increase of 1°C in ambient air temperature increased the RR of TCM (OR 1.053 at lag 3; IC 95%: 1.021–1.086). No significant association was found between TCM and PM10, PM2.5, NO2at any lag. During the warm period, each increase in 10μg/m3 in ozone from lag 1 to 3 increased the risk of TCM (OR 1.089 at lag 3, IC 95%: 1.017–1.168). Conclusions Air temperature strongly influences the onset of TCM. Both cold spells and heat waves seem to be associated with the development of TCM. Ozone exposure also increases the risk of TCM during the warm period, whereas particulate and NO2 pollution do not seem to play a significant role. These patterns seem to differ from those previously reported with STEMI.