Value of cardiac biomarkers in the early diagnosis of Takotsubo syndrome - 25/12/18
Résumé |
Background |
Bedside diagnosis between Takotsubo syndrome (TTS) and ACS remains challenging and requires multimodal examinations. Because invasive procedures portend by themselves a sizeable ischemic and bleeding risk in this frail population, non-invasive criteria are warranted to enable early diagnosis.
Methods and results |
A total of 1100 patients (TTS n=314, STEMI n=452, NSTEMI n=334) were enrolled in two centers. Baseline clinical and biological characteristics were compared between groups. At admission, cut-off values of BNP/TnI ratio of 54 and 329 distinguished respectively STEMI from NSTEMI, and NSTEMI from TTS. Best differentiation between TTS and ACS was obtained by the use of BNP/TnI ratio at peak (cut of value of 6 discriminated STEMI from NSTEMI, and 115 distinguished NSTEMI from TTS). We developed a score including 5 routinely available parameters (age, gender, history of psychiatric disorders, LVEF and BNP/TnI ratio on admission) enabling good distinction between TTS and STEMI 77% specificity and 92% sensitivity, AUC 0.93 (95% CI 0.92–0.95). For the distinction between TTS and NSTEMI, a second 4 variables score (gender, history of psychiatric disorders, LVEF on admission, BNP on admission) achieved a good diagnostic performance Se 89%, Sp 85%, AUC 0.94 (95% CI 0.92-0.96) (Table 1).
Conclusion |
A distinctive cardiac biomarker profile exists during TTS enabling at an early stage the differentiation between TTS and various myocardial infarction patterns. Best discrimination between TTS and ACS was obtained using a 4 (NSTEMI) or 5 variables score (STEMI).
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Vol 11 - N° 1
P. 143 - janvier 2019 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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