Abstract
Background: Bedside diagnosis between Takotsubo syndrome (TTS) and ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction remains challenging. We sought to determine a cardiac biomarker profile to enable their early distinction. Methods: 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. Results: At admission, cut-off values of BNP (B-type natriuretic peptide)/TnI (Troponin I) ratio of 54 and 329 distinguished respectively STEMI from NSTEMI, and NSTEMI from TTS. Best differentiation was obtained by the use of BNP/TnI ratio at peak (cut-of values of 6 and 115 discriminated respectively STEMI from NSTEMI, and NSTEMI from TTS). We developed a score including five parameters (age, gender, history of psychiatric disorders, LVEF, and BNP/TnI ratio at admission) enabling good distinction between TTS and STEMI (77% specificity and 92% sensitivity, AUC 0.93). For the distinction between TTS and NSTEMI, a four variables score (gender, history of psychiatric disorders, LVEF, and BNP at admission) achieved a good diagnostic performance (89% sensitivity, 85% specificity, AUC 0.94). Conclusion: A distinctive cardiac biomarker profile enables at an early stage a differentiation between TTS and ACS. A four (NSTEMI) or five variables score (STEMI) permitted a better discrimination.
Highlights
Takotsubo syndrome (TTS) can be broadly defined as a transient left ventricular dysfunction clinically sharing many features of myocardial infarction such as acute chest pain, ECG changes and troponin rise
TTS is presumably associated to an acute inflammatory disorder as suggested by the systemic inflammatory response syndrome found in a large proportion of TTS patients (45%) in a recent study of 215 patients [2]
We sought to determine whether a distinctive cardiac biomarker profile exists during TTS enabling at an early stage, the differentiation between TTS and various myocardial infarction patterns
Summary
Takotsubo syndrome (TTS) can be broadly defined as a transient left ventricular dysfunction clinically sharing many features of myocardial infarction such as acute chest pain, ECG changes and troponin rise. Initially presumed to be rare, TTS is increasingly recognized as an important differential diagnosis of acute coronary syndrome (ACS), representing 1 to 2% of these patients, and up to 8 to 10% in women [3]. In nearly 60% of cases, TTS mimics non-ST-segment elevation myocardial infarction (NSTEMI) presentation, whilst a ST segment elevation could be evidenced in almost 40% of cases [8]. The differential diagnosis between TTS and ACS remains often difficult to assess and requires complementary examinations including renewed echocardiography, cardiac magnetic resonance imaging (MRI), or myocardial tomography.
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