Abstract 15659: A Biomarker Strategy for the Early Diagnosis of Takotsubo Cardiomyopathy
Background: Takotsubo cardiomyopathy (TCM) is characterized by reversible left ventricular dysfunction in response to an acute emotional or physical stress. Because the clinical presentation of TCM mimics that of acute ST elevation myocardial infarction (STEMI), establishing an early differential diagnosis is imperative. Our aim was to asses the value of a biomarker strategy utilizing the ratio of N-terminal pro-brain natriuretic peptide (pBNP) to troponin T levels (TnT) (pBNP-to-TnT) for discrimination between TCM and acute STEMI.
Methods: Patients admitted with TCM were compared to patients with acute STEMI. The levels of pBNP and TnT were obtained upon admission and repeated in the first 6-8 hours of admission. Excluded were patients with renal dysfunction.
Results: TCM patients (n=23) were compared with acute STEMI patients (n=43). TCM patients were older (72 vs. 62 years) and more likely female (100% vs. 33%) but had similar comorbid conditions. Peak median pBNP levels differed between the TCM and STEMI groups (3,648 vs. 271 pg/ml; p<0.05). Median pBNP-to-TnT ratios differed between TCM and STEMI patients (17,157 vs. 240; p<0.05). ROC curve for the diagnosis TCM showed that a pBNP-to-TnT ratio of >3000 yielded an area under the curve of 0.969 (95% CI 0.89 to 0.99; p<0.001), with sensitivity 78%, specificity 100%, and positive and negative predictive values of 100% and 90%, respectively.
Conclusions: The ratio of pBNP-to-TnT is an easy, fast and broadly available biomarker strategy to aid in the early differentiation between TCM and acute STEMI.
- © 2011 by American Heart Association, Inc.