[Differential circadian rhythms in myocardial infarction according to its extent by electrocardiogram]
José Garmendia-Leiza1, Juan Bautista López-Messa, Jesús María Andrés-de-Llano
1Laboratorio de Cronobiología, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain. irgarmenl@tiscali.es
Insights
Acute myocardial infarction (AMI) onset exhibits a daily circadian rhythm, confirmed in both Q-wave and non-Q-wave infarction types. This pattern suggests distinct underlying mechanisms for different heart attack presentations.
Area of Science:
- Cardiology
- Chronobiology
- Epidemiology
Background:
- Acute myocardial infarction (AMI) is a leading cause of mortality worldwide.
- Understanding the temporal patterns of AMI onset can inform preventative strategies.
- Previous research suggests a potential circadian influence on cardiovascular events.
Purpose of the Study:
- To investigate the presence and characteristics of circadian rhythm in the timing of AMI onset.
- To compare circadian patterns between Q-wave and non-Q-wave myocardial infarctions.
Main Methods:
- Retrospective analysis of 54,249 infarctions from the Spanish ARIAM multicentre study.
- Utilized multiple-sinusoid cosinor analysis with 24, 12, and 8-hour periods to detect circadian rhythm.
- Analyzed patient demographics, risk factors, and electrocardiographic infarction type (Q-wave vs. non-Q-wave).
Main Results:
- A statistically significant circadian rhythm was observed in the overall time of AMI pain onset (p < 0.0000).
- This circadian pattern was present in both Q-wave (single morning peak) and non-Q-wave (bimodal peaks) infarction subgroups (p < 0.0000).
- Significant differences were found in the circadian curves between Q-wave and non-Q-wave infarctions (p < 0.0000).
Conclusions:
- The onset of acute myocardial infarction follows a discernible circadian rhythm.
- Distinct circadian patterns in Q-wave and non-Q-wave infarctions suggest different pathophysiological mechanisms.
- The cosinor model with three components effectively identified circadian rhythms in AMI onset.
Background And Objective:
To determine the existence of circadian rhythm in the time of onset of acute myocardial infarction (AMI) according to their extension type (Q-wave vs. non-Q-wave).
Patients And Method:
We studied a retrospective cohort of patients from a multicentre study of myocardial infarction (ARIAM study group). We collected information about 54,249 infarctions from the data base of the ARIAM (Analysis of Delay in AMI) Spanish multicentre study. The following variables were analysed: general variables --age, gender, previous ischemic heart disease, outcome at coronary care unit, infarction electrocardiograph type (Q wave or non-Q wave) and location of AMI--, cardiovascular risk factors, and previous drug treatment of the patients. To verify the presence of circadian rhythm we developed a simple test of equality of time series based on the multiple-sinusoid cosinor analysis. Three sinusoids (24-12-8 h periods) were used.
Results:
The time of pain onset shows circadian rhythm (p < 0.0000), which also is observed in both infarction electrocardiograph characteristics subgroups (Q-wave infarction and non-Q-wave infarction) (p < 0.0000). Q-wave infarction shows sinusoid curve with one maximum morning peak and non-Q-wave shows bimodal curve, with two peaks. Comparison between their curves shows statistical significance (p < 0.0000).
Conclusions:
AMI onset follows a circadian rhythm pattern, which is also observed in analysed subgroups. Differences in the circadian rhythm according to the Q/non-Q wave infarction characteristics, could be determined by different physiopathologic mechanism. The cosinor model fit with three components (24, 12 and 8-hour-periods) show good sensitivity to determine circadian rhythm.
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