The differential diagnostic value of selected cardiovascular biomarkers in Takotsubo syndrome

Topf, Albert; Mirna, Moritz; Paar, Vera; Motloch, Lukas J.; Grueninger, Janine; Dienhart, Christiane; Schulze, P. Christian; Brandt, Mathias C.; Larbig, Robert; Hoppe, Uta C.; Kretzschmar, Daniel; Lichtenauer, Michael

doi:10.1007/s00392-021-01956-2

Cited by 11 publications

(26 citation statements)

References 35 publications

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“…So far, many other biomarkers have been studied and proposed. Acutely, IL-6 and CXCL1 chemokine have been shown to increase in TC patients, and, after 5 months of follow-up, an early increase in serum IL-8 concentration has been reported [ 40 ]. In a recent study, ST-2 has been proposed as a new possible biomarker for the differential diagnosis of acute coronary syndrome from TC because it was significantly elevated in TC compared to ACS patients [ 41 , 42 ].…”

Section: Discussionmentioning

confidence: 99%

“…A recent study shed light on a ST-2, a member of the interleukin-1 receptor family that acts both as a membrane receptor (ST-2) and as a secreted protein (sST-2). It is expressed by cardiomyocytes and cardiac fibroblasts as a marker of cardiac mechanical strain [ 40 ]. ST-2 was significantly elevated ( p = 0.012) in TC patients, with an optimal cut-off of 11,018.06 pg/mL.…”

Section: Cardiological Assessment and Diagnosis Of Takotsubo Cardiomy...mentioning

confidence: 99%

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The Octopus Trap of Takotsubo and Stroke: Genetics, Biomarkers and Clinical Management

Canavero

Rifino

Bussotti

et al. 2022

JPM

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Takotsubo cardiomyopathy (TC) is a reversible cardiomyopathy mimicking an acute coronary syndrome, usually observed in response to acute stress situations. The association between acute ischemic stroke and TC is already known, since it has been previously reported that ischemic stroke can be both a consequence and a potential cause of TC. However, the precise pathophysiological mechanism linking the two conditions is still poorly understood. The aim of our review is to expand insights regarding the genetic susceptibility and available specific biomarkers of TC and to investigate the clinical profile and outcomes of patients with TC and stroke. Since evidence and trials on TC and stroke are currently lacking, this paper aims to fill a substantial gap in the literature about the relationship between these pathologies.

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Section: Discussionmentioning

confidence: 99%

Section: Cardiological Assessment and Diagnosis Of Takotsubo Cardiomy...mentioning

confidence: 99%

The Octopus Trap of Takotsubo and Stroke: Genetics, Biomarkers and Clinical Management

Canavero

Rifino

Bussotti

et al. 2022

JPM

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“…It presents with symptoms similar to an acute myocardial infarction, but is considered a heart failure condition. Three percent of all suspected acute coronary syndromes (ACS) are caused by TTS [ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…TTS causes reversible wall motion abnormalities involving apical, mid-ventricular, or basal segments of the left ventricle and is defined by acute left ventricular dysfunction in the absence of a significant coronary stenosis. [ 1 , 3 ]. While 96% of cases show a nearly full recovery with resolution of the wall motion abnormalities within a few days, TTS can be potentially life threatening with a mortality rate of one to two percent in the acute phase [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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Introduction: Treatment with betablockers is controversial in Takotsubo syndrome (TTS); however, many physicians intuitively initiate or continue betablocker therapy in these patients. The effect of preadmission betablocker use on adverse cardiovascular events has not been studied in the literature. Methods: To investigate this issue, we evaluated clinical complications, defined by the endpoint of occurrence of hemodynamically relevant arrythmia, cardiac decompensation, and all-cause adverse cardiac events, during hospitalization, in 56 patients hospitalized for TTS between April 2017 and July 2021. We compared the risk of adverse cardiovascular events between patients with preadmission betablocker therapy and those without preadmission betablocker therapy. Pretreatment betablocker therapy was defined as daily betablocker intake for more than a week including day of admission. Results: TTS patients taking preadmission betablockers had a significantly increased risk of all-cause complications relative to patients without betablockers in preadmission medication ((52.0% vs. 19.4%, p = 0.010; OR 4.5 (95% Cl 1.38–14.80)). Furthermore, TTS patients already taking betablockers on admission showed a statistically significant increased risk of cardiac decompensation when compared to patients without pretreatment with betablockers (p = 0.013). There were no significant differences in patient characteristics in patients who were taking beta blockers as an adjunct therapy prior to admission for TTS relative to those who were not. There is however an increase in comorbidities, hypertension, and atrial fibrillation, in past medical history in patients taking a preadmission betablocker. The difference is related to therapeutic applications for beta blockers and was not significant based on endpoints of our study. Conclusions: Preadmission betablocker treatment was associated with a 4.5 times higher risk of adverse cardiac events. This increased risk of all-cause complications and of cardiac decompensation within the acute phase of TTS is presumably due to the negative inotropic effects of betablockers and upregulation of β-adrenergic receptors in patients with chronic betablocker therapy.

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“…Takotsubo cardiomyopathy constitutes a form of cardiomyopathy with transient left ventricular dysfunction. Clinical symptoms, electrocardiographic alterations, and changes in cardiac biomarkers may be similar to acute coronary syndrome (ACS) [ 1 ]. Approximately 1–2% of all patients and up to 10% of women with suspected acute coronary syndrome (ACS) are later diagnosed with TTC [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

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

Topf

Mirna

Bacher

et al. 2022

Life

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Introduction: Takotsubo cardiomyopathy (TTC) and acute coronary syndrome (ACS) are clinically indistinguishable from each other. Although therapeutically redundant, coronary angiography remains indispensable for differential diagnosis. Methods: In our study, we compared hemogram parameters and their ratios in 103 patients presenting with undiagnosed chest pain. Blood was drawn at baseline in 40 patients with TTC, 63 patients with ACS, and 68 healthy controls ((Ctrl) no coronary artery disease or signs of heart failure). Results: Peripheral lymphocyte counts were significantly depressed in TTC and ACS patients when compared to the Ctrl. Consequently, all three investigated hemogram ratios were significantly elevated in patients with ACS or TTC (NLR: TTC: median 3.20 vs. ACS: median 3.82 vs. Ctrl: median 2.10, p < 0.0001; BLR: median 0.02 vs. ACS: median 0.00 vs. Ctrl: median 0.00, p < 0.0001; MLR: median 0.37 vs. ACS: median 0.44 vs. Ctrl: median 0.28, p < 0.0001). Of note, BLR was only significantly elevated in patients with TTC, and not in patients with ACS (ACS vs. Ctrl p = 0.183). Conclusion: Basophil count and BLR are significantly increased in TTC patients when compared to ACS and may, therefore, be helpful in the distinction of TTC from ACS. Whereas NLR might be useful to differentiate ACS from controls. Elevated basophil counts and BLR in TTC patients are interesting findings and may confirm speculations about the partly unexplained pathophysiology.

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The differential diagnostic value of selected cardiovascular biomarkers in Takotsubo syndrome

Cited by 11 publications

References 35 publications

The Octopus Trap of Takotsubo and Stroke: Genetics, Biomarkers and Clinical Management

The Octopus Trap of Takotsubo and Stroke: Genetics, Biomarkers and Clinical Management

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

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

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