The role of peak NT-proBNP/peak cardiac troponin T ratio obtained within 3 days of admission to discriminate Takotsubo from acute coronary syndrome

Abstract

Background Takotsubo syndrome (TS) is not usually diagnosed until a patient with suspected acute coronary syndrome (ACS) is found to have no hemodynamically significant lesions on coronary angiography (CA). Purpose We explored whether a cardiac biomarker profile can contribute to early diagnosis of TS, which could be useful when CA is either not available or does not provide a definitive diagnosis. Methods Ratios of N-terminal-pro brain natriuretic peptide (NT-proBNP) and cardiac troponin T (cTnT) [admission and peak levels of the two consecutive days following admission, expressed in pg/mL] were compared in 41 patients with TS and 50 ACS patients. Results Both admission NT-proBNP/cTnT ratio and peak NT-proBNP/peak cTnT ratio were higher in patients with TS compared to those with ACS (38.8±57.1 vs 15.2±33.1, p=0.038 and 29.1±26.2 vs 2.2±3.9, p<0.001, respectively). Only the association of peak NT-proBNP/peak cTnT ratio remained statistically significant after adjustment for age and gender when multiple linear regression analysis was used (R square=0.746, p<0.001). ROC curve analysis of peak NT-proBNP/peak cTnT ratio discriminated patients with TS as opposed to those with ACS (AUC=0.921 with 95% CI: 0.851–0.990, p<0.001). A cut-off value of peak NT-proBNP/peak cTnT ratio >5.5 had a sensitivity of 85%, a specificity of 90% and an accuracy of 88.1% in detecting TS as opposed to ACS. Conclusions Peak NT-proBNP/peak cTnT ratio >5.5 obtained within the first 3 days of admission has a good diagnostic accuracy to identify patients with TS among those presenting with ACS. This could be useful for the early discrimination between the two entities when CA is not easily available, particularly in patients without ST-segment elevation and low or intermediate-risk. Funding Acknowledgement Type of funding sources: None.

The research progress and research trends in acute coronary syndrome nursing: A review of visual analysis based on the Web of Science database

“…[ 24 ] For the early identification and diagnosis of patients with ACS, an increasing number of studies have focused on the use of biomarkers to make judgments, among which immediate measurement of cardiac troponin is a common method. [ 25 , 26 ] Some studies have shown that the heart fatty acid binding protein also has potential diagnostic value in the early period after the onset of ACS symptoms, [ 27 , 28 ] but further validation studies on new predictors are needed to identify and diagnose patients as early as possible, and to take early interventions to improve therapeutic outcomes and survival rates. Percutaneous coronary intervention, as a special treatment modality, significantly solves the reperfusion situation of ACS patients, and its post-procedure care and recovery have also attracted much attention.…”