Diagnostic Utility of Cardiac Biomarkers in Discriminating Takotsubo Cardiomyopathy From Acute Myocardial Infarction

Randhawa, Mandeep Singh; Dhillon, Ashwat; Taylor, Harris C.; Sun, Zhiyuan; Desai, Milind Y.

doi:10.1016/j.cardfail.2013.12.004

Cited by 70 publications

(72 citation statements)

References 28 publications

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“…differences in CKMB values were observed on admission and at the corresponding peak troponin sample times. As previously reported with conventional troponin [9,10,13,15], the ratio of NT-proBNP to hs-TnT proved to be significantly different (Table 2) between TT and MI patients (NT-proBNP available in 23 and 26 patients respectively). ROC curves (Fig.…”

Section: Resultssupporting

confidence: 76%

“…Of these, the ratio of BNP or NT-proBNP to troponin has been extensively studied [9,10,13,15]. Of note, two of these studies only compared TT with STEMI patients in whom management would not be altered on the basis of biomarkers which are often available only after coronary angiography.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, clinicians are frequently confronted with challenging cases where diagnosis is equivocal especially when imaging of the left ventricle is performed late in the clinical course. Moreover, many authors now suggest that invasive imaging may not be necessary in patients presenting without ST segment elevation [9,10]. In this setting, much research has been conducted to find discriminatory markers between acute coronary syndromes, especially ST-segment elevation myocardial infarction (STEMI), and TT as appropriate diagnosis has important implications with regards to management and prognosis.…”

Section: Introductionmentioning

confidence: 99%

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Ratio of high-sensitivity troponin to creatine kinase-MB in takotsubo syndrome

Pirlet

Piérard

Legrand

et al. 2017

International Journal of Cardiology

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Background: Takotsubo syndrome (TT) and myocardial infarction (MI) share numerous similarities in clinical presentation, ECG modifications and biomarker elevation. We sought to determine whether the ratio of highsensitivity cardiac troponin T (hs-TnT) to the myocardial fraction of creatine kinase (CKMB) could be a potent discriminator between TT and MI patients. Methods: We separately present analysis of data from retrospective files and prospectively recruited patients presenting with TT (35 retrospective and 42 prospective), NSTEMI (48 retrospective and 75 prospective) and STEMI (20 retrospective and 39 prospective). We compared ratios of hs-TnT to CKMB on admission to the hospital between TT, NSTEMI and STEMI patients. Receiver operating characteristic (ROC) curves were analysed to determine optimal cut-off values. Conclusion: hs-TnT/CKMB ratio is a novel, readily available parameter that could be used alongside clinical risk scores, other biomarkers and ECG findings to discriminate between TT and MI.

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Section: Resultssupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Ratio of high-sensitivity troponin to creatine kinase-MB in takotsubo syndrome

Pirlet

Piérard

Legrand

et al. 2017

International Journal of Cardiology

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“…At present, advanced cardiac imaging such as cardiac CT 6 or magnetic resonance imaging 7 have been proposed to make the distinction but these imaging studies are neither available widely nor are they practical in critically ill patients. Previous studies have proposed the use of EKG criteria 8,9, cardiac biomarkers 10,11 and echocardiography 1,12 to distinguish the two conditions. This study intended to compare the presentation findings of TCM and STEMI patients in moderately larger number of patients combining laboratory, EKG and echocardiographic findings for more specific prediction model.…”

Section: Discussionmentioning

confidence: 99%

“…Mean QTc was significantly prolonged in TCM (470ms versus 443ms, p=0.001). The presence of QTc prolongation in TCM has been reported in the past 10 . The cause of this is not clearly known but has been suggested to be a result of catecholamine induced repolarization abnormality 9,13-15 .…”

Section: Ekg Criteriamentioning

confidence: 93%

'GET QT': Clinical Criteria to Differentiate Takotsubo Cardiomyopathy from STEMI

Vaidya¹,

Jaiswal²,

Madhira³

2016

ICFJ

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Introduction: Presentation of Takotsubo cardiomyopathy (TCM) may closely mimic ST-elevation myocardial infarction (STEMI) and clinicians are often faced with a dilemma when cardiac catheterization is unavailable or contraindicated.Methods: Age-matched 42 TCM and 55 STEMI patients admitted in SUNY Upstate Hospital, Syracuse, NY were retrospectively compared for characteristics at presentation.Results: 12 TCM patients (26%) had ST elevations in the initial EKG. Mean QTc interval was significantly prolonged in TCM (469ms vs 443ms,p=0.001). The peak Troponin T (TnTp) level in TCM was significantly less(1.15ng/ml vs 6.04ng/ml;p=0.001) and the time to peak troponin T (Tp) was lower(3.7 hours versus 12.4 hours,p=0.001). Mean LV ejection fraction(EF) was 36% in TCM versus 47.4% in STEMI (p=0.001).Significance (p<0.05) was noted for 5 predictors on multiple regression namely: Gender, EF, TnTp, QTc interval and Tp. A prediction model was then developed, giving a score of one for each positive finding: female gender, EF< 40%, TnTp< 2ng/ml, QTc> 470ms in the initial EKG and Tp< 6 hours (GET QT criteria). The presence of 3 or more predictors had a sensitivity of 88.8%, specificity of 95.1% and negative predictive value of 90.9% to diagnose TCM. Though there have been recent publications proposing various criteria to distinguish the two diseases, this is the first proposing highly specific and all-inclusive combined laboratory, EKG and echocardiography criteria.Conclusion: Females with early and low peaking troponins; prolonged QTc; low EF were likely to have TCM. With the proposed prediction model- presence of 3 or more factors is highly specific to diagnose TCM.

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A rare case of Takotsubo syndrome in a patient 5 months after heart transplantation

et al. 2019

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Takotsubo syndrome is an acute heart failure syndrome with a pathogenesis that is attributed to sympathetic stimulation. This case report describes a unique case of a 5 month heart‐transplanted female patient who developed apical ballooning on an echocardiography exam performed following an emotional stress event. Detailed clinical investigations and imaging techniques confirmed the diagnosis of Takatsubo syndrome. Our case indicates that Takatsubo's cardiomyopathy should be included in the differential diagnosis of heart‐transplanted patients presenting with sudden graft dysfunction mimicking acute graft rejection or acute coronary syndrome.

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Diagnostic Utility of Cardiac Biomarkers in Discriminating Takotsubo Cardiomyopathy From Acute Myocardial Infarction

Cited by 70 publications

References 28 publications

Ratio of high-sensitivity troponin to creatine kinase-MB in takotsubo syndrome

Ratio of high-sensitivity troponin to creatine kinase-MB in takotsubo syndrome

'GET QT': Clinical Criteria to Differentiate Takotsubo Cardiomyopathy from STEMI

A rare case of Takotsubo syndrome in a patient 5 months after heart transplantation

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