Value of cardiac biomarkers in the early diagnosis of Takotsubo syndrome

Abstract

Bedside diagnosis between Takotsubo syndrome (TTS) and ACS remains challenging and requires multimodal examinations. Because invasive procedures portend by themselves a sizeable ischemic and bleeding risk in this frail population, non-invasive criteria are warranted to enable early diagnosis. A total of 1100 patients (TTS n = 314, STEMI n = 452, NSTEMI n = 334) were enrolled in two centers. Baseline clinical and biological characteristics were compared between groups. At admission, cut-off values of BNP/TnI ratio of 54 and 329 distinguished respectively STEMI from NSTEMI, and NSTEMI from TTS. Best differentiation between TTS and ACS was obtained by the use of BNP/TnI ratio at peak (cut of value of 6 discriminated STEMI from NSTEMI, and 115 distinguished NSTEMI from TTS). We developed a score including 5 routinely available parameters (age, gender, history of psychiatric disorders, LVEF and BNP/TnI ratio on admission) enabling good distinction between TTS and STEMI 77% specificity and 92% sensitivity, AUC 0.93 (95% CI 0.92–0.95). For the distinction between TTS and NSTEMI, a second 4 variables score (gender, history of psychiatric disorders, LVEF on admission, BNP on admission) achieved a good diagnostic performance Se 89%, Sp 85%, AUC 0.94 (95% CI 0.92-0.96) ( Table 1 ). A distinctive cardiac biomarker profile exists during TTS enabling at an early stage the differentiation between TTS and various myocardial infarction patterns. Best discrimination between TTS and ACS was obtained using a 4 (NSTEMI) or 5 variables score (STEMI).