Analysis of Selected Cardiovascular Biomarkers in Takotsubo Cardiomyopathy and the Most Frequent Cardiomyopathies

Abstract

Introduction: Among the causes of de novo diagnosed cardiomyopathy, Takotsubo cardiomyopathy (TTC) plays a minor role, with an occurrence of 50,000–100,000 cases per annum in the United States. In clinical practice, a differentiation of a TTC toward an ischemic cardiomyopathy (ICMP) or a dilatative cardiomyopathy (DCMP) appears to be challenging, especially in a subacute setting or in atypical types of TTC.Methods: To investigate this issue, we analyzed serum levels of sST2, GDF-15, suPAR, HFABP, and clinical parameters including echocardiography in 51 patients with TTC, 52 patients with ischemic cardiomyopathy (ICMP) and 65 patients with dilated cardiomyopathy (DCMP).Results: sST-2 seemed to be the most promising biomarker for prediction of a TTC in differential diagnosis to an ICMP (AUC: 0.879, p = < 0.001, Cut off values: 12,140.5 pg/ml) or to a DCMP (AUC: 0.881, p = < 0.001, cut off value: 14521.9 pg/ml). GDF-15 evidenced a slightly lower AUC for prediction of a TTC in differential diagnosis to an ICMP (AUC: 0.626, p = 0.028) and to a DCMP (AUC: 0.653, p = 0.007). A differential diagnostic value was found for H-FABP in the prediction of a DCMP compared to TTC patients (AUC: 0.686, p = < 0.001). In propensity score matching for left ventricular ejection fraction, sex, and cardiovascular risk factors, differences in the plasma levels of sST2 and H-FABP in the matched cohort of TTC vs. DCMP remained statistically significant. In the matched cohort of TTC vs. ICMP, differences in sST2 also remained statistically significantConclusion: As medical therapy, long term prognosis, interval of follow-ups, rehabilitation program and recommendations differ completely between TTC and ICMP/DCMP, biomarkers for differential diagnosis, or rather for confirmation of diagnosis, are warranted in cases of cardiomyopathies with unsure origin. sST-2, GDF-15 and H-FABP might facilitate the classification.

Perspectives on Resolving Diagnostic Challenges between Myocardial Infarction and Takotsubo Cardiomyopathy Leveraging Artificial Intelligence

“…This aligns with previous findings indicating that inflammation and oxidative stress play significant roles in the pathogenesis of takotsubo cardiomyopathy (TTC) [42,43]. GDF-15 exhibited the highest levels in takotsubo cardiomyopathy (TTC) compared to ischemic cardiomyopathy (ICMP), dilated cardiomyopathy, the combined group of ICMP [37], and ACS [44], indicating its potential value in differential diagnosis.…”

“…Interestingly, in a relatively small study, it was observed that the highest plasma levels of H-FABP were found in patients with dilated cardiomyopathy (DCMP), followed by levels in patients with ischemic cardiomyopathy (ICMP), and with a significant difference, lower levels were seen in patients with takotsubo cardiomyopathy (TTC). This finding suggests a potential clinical utility of H-FABP as a marker for distinguishing between DCMP and TTC [37]. Given that myocardial stunning is the underlying pathogenesis in takotsubo cardiomyopathy (TTC), it appears that TTC patients exhibit lower levels of myocardial stress compared to clinically compensated dilated cardiomyopathy (DCMP) patients [41].…”

“…sST-2 levels were significantly higher in TTC patients compared to patients with ICMP in a relatively small study. A receiver operating characteristic (ROC) analysis showed that SST-2 was a valuable diagnostic biomarker for identifying TTC when compared to ICMP [37].…”

Pretreatment with Betablockers, a Potential Predictor of Adverse Cardiovascular Events in Takotsubo Syndrome

“…Life-threatening ventricular arrhythmias are observed in 8.6% of TTS patients. Left ventricular wall rupture, cardiogenic shock, and thrombosis are also reported [ 6 ].…”

Differences of Hemogram Parameters and Their Ratios among Patients with Takotsubo Syndrome, Acute Coronary Syndrome and Healthy Individuals

“…TTC predominantly affects postmenopausal women and is usually triggered by physical or emotional stress factors. The left ventricle typically demonstrates apical ballooning and basal hypercontractility but also midventricular, basal, as well as focal left ventricular contractile abnormalities can be seen [ 3 ]. Inflammation, sympathetic overdrive-mediated multi-vessel epicardial spasms, microvascular dysfunction, and direct toxicity of catecholamines have been proposed as pathophysiological mechanisms [ 4 ].…”