Abstract
Introduction: Takotsubo syndrome is a complex entity that, although it usually has a good prognosis, can be life threatening. While recent advances have improved the knowledge of takotsubo syndrome, many aspects of its etiology still remain uncertain. Metabolomics, a hypothesis generating approach, could provide novel pathophysiology information about this disease. Methods and Results: Serum samples were obtained from takotsubo (n = 19) and acute myocardial infarction patients (n = 8) at the cath lab and, in the case of takotsubo, again once the patient had recovered, 3 months after the main event. 1H NMR spectra of the serum were acquired at 9.4T using a CPMG pulse sequence (32 ms effective delay). Supervised and unsupervised pattern recognition approaches where applied to the data. Pattern recognition was able to differentiate between takotsubo and acute myocardial infarction during the acute phase with 95% accuracy. Myocardial infarction patients showed an increase in lipid signals, a known risk factor for the disease while takotsubo patients showed a relative increase in acetate that could suggest a reduced turnover of the Krebs cycle. When comparing acute and recovered phases, we could detect an increase in alanine and creatine once patients recovered. Conclusions: Our results demonstrate that takotsubo syndrome is metabolically different than AMI, showing limited myocardial energy production capacity during the acute phase. We achieved high classification success against AMI; however, this study should be considered as a proof of concept regarding clinical application of metabolic profiling in takotsubo cardiomyopathy.
Highlights
Takotsubo syndrome is a complex entity that, it usually has a good prognosis, can be life threatening
Takotsubo syndrome (TKS), called apical ballooning syndrome, is a non-ischemic cardiomyopathy characterized by transient apical dyskinesia
We identified the particular 1 H NMR-based metabolic fingerprinting of serum samples from TKS patients, providing novel information on the differentiation between this disorder and the acute myocardial infarction (AMI) in the acute phase, and describing the temporal evolution of the metabolic pattern in the acute and subacute phases, giving new insights into the pathophysiology of the TKS
Summary
Takotsubo syndrome is a complex entity that, it usually has a good prognosis, can be life threatening. Methods and Results: Serum samples were obtained from takotsubo (n = 19) and acute myocardial infarction patients (n = 8) at the cath lab and, in the case of takotsubo, again once the patient had recovered, 3 months after the main event. Pattern recognition was able to differentiate between takotsubo and acute myocardial infarction during the acute phase with 95% accuracy. Conclusions: Our results demonstrate that takotsubo syndrome is metabolically different than AMI, showing limited myocardial energy production capacity during the acute phase. Clinical presentation usually mimics an acute myocardial infarction (AMI), including chest pain, electrocardiogram (EKG) changes (frequently ST elevation), and apical dyskinesia, but without coronary occlusion or significant coronary disease as the underlying mechanism of the acute event [1]. Despite contractility disturbances being reversible and the recovery of ejection fraction usually complete, TKS is far from being benign, potentially leading to heart failure, mainly in patients with other comorbidities and poor previous functional class [4,5]
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