Abstract 18921: Utility of a TTC Score to facilitate differentiation of Tako-Tsubo Cardiomyopathy from Ischemic ACS
Introduction: The diagnosis of tako-tsubo cardiomyopathy (TTC) is often made by default after emergent cardiac catheterization and potentially the inappropriate administration of thrombolytics or catecholamines. In view of the distinct pathogenesis of TTC, it is important that TTC be distinguished from ischemic ACS, clinically, if possible. We now report the utility of an arbitrarily derived “TTC score” based on clinical features of TTC versus ACS.
Methods: Consecutive TTC (n=99) and female ACS (N=56) patients of similar ages were compared. The TTC score allocated 1 point for troponin T elevation, 1 or 2 points for NT-proBNP to ≥3000 or ≥6000pg/ml respectively, and 1 or 2 points for regional and multiregional ECG changes respectively, with analyses based on data at 24 hours post presentation. Additional analyses were performed to evaluate the potential additional impact of histories of antecedent severe stress, and that of the presence/absence of hemodynamic compromise (Killip Class ≥2).
Results: Scores were substantially different (see Figure; TTC group median 4, vs. 2 in the ACS group; p<0.0001). Receiver operator curve analysis demonstrated an area under the curve (AUC) of 0.74 (P<0.0001), with 62% sensitivity and 75% specificity for a score ≥4. This differentiation was based primarily on NT-proBNP levels (median 5990 vs 1600 pg/ml). The rate of antecedent stressor exposure for TTC patients was 82%: modeling of imputed stressor exposure rates of 25 and 50% for ACS patients improved specificity to 79 and 75% respectively. The TTC score separated diagnostic groups in Killip 1 (AUC 0.80, P<0.0001), but not in Killip ≥2 (AUC 0.66, P=NS).
Conclusion: This TTC score facilitates differentiation of TTC from ischemic ACS, in the absence of pulmonary congestion/shock. Early diagnosis of TTC is an essential precursor to the development of disease-specific therapeutic regimens.
- © 2012 by American Heart Association, Inc.