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. 2022 Feb;111(2):197-206.
doi: 10.1007/s00392-021-01956-2. Epub 2021 Nov 2.

The differential diagnostic value of selected cardiovascular biomarkers in Takotsubo syndrome

Albert Topf  1 , Moritz Mirna  2 , Vera Paar  2 , Lukas J Motloch  2 , Janine Grueninger  2 , Christiane Dienhart  3 , Paul C Schulze  4 , Mathias C Brandt  2 , Robert Larbig  5 , Uta C Hoppe  2 , Daniel Kretzschmar  4 , Michael Lichtenauer  2
Affiliations

The differential diagnostic value of selected cardiovascular biomarkers in Takotsubo syndrome

Albert Topf et al. Clin Res Cardiol. 2022 Feb.

Erratum in

Abstract

Introduction: Takotsubo syndrome (TTS) is clinically indistinguishable from an acute coronary syndrome (ACS). In the absence of valid markers for differential diagnosis, coronary angiography has been indispensable.

Methods: In our study, we evaluated the serum levels of sST-2, GDF-15, suPAR and H-FABP in 92 patients with the suspicion of TTS (51 TTS and 41 ACS patients) and 40 gender matched controls (no coronary artery disease or signs of heart failure) at baseline.

Results: H-FABP was significantly higher in ACS patients compared to TTS patients. Even in in propensity score matching for left ventricular ejection fraction, sex and cardiovascular risk factors, differences in the plasma levels of H-FABP in the matched cohort of TTS vs ACS remained statistically significant. Whereas, sST-2 was significantly elevated in TTS patients. H-FABP was superior for prediction of an ACS with even higher accuracy than hs troponin in differential diagnosis (AUC 0.797, p ≤ 0.0001); the optimal cut off for discrimination towards a TTS was calculated as 2.93 ng/ml (sensitivity 70.0%, specificity 82.4%, PPV 75.7%, NPV 77.4%). sST-2 seemed most appropriate for identification of a TTS (AUC 0.653, p = 0.012). The optimal cut off for differential diagnosis was 11018.06 pg/ml (sensitivity 82.0%, specificity 51.2%, PPV 69.4%, NPV 71.9 %).

Conclusion: H-FABP and sST-2 are the most promising markers with better accuracy than preexisting biomarkers in differential diagnosis in our study and therefore, could be crucial for the guidance of treatment in patients with high bleeding risk, advanced renal failure or multimorbidity.

Keywords: Acute coronary syndrome; Biomarkers; Differential diagnosis; Takotsubo cardiomyopathy.

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Conflict of interest statement

Not applicable.

Figures

Fig. 1
Fig. 1
Comparison of biomarker levels between control group, TTS, and ACS patients
Fig. 2
Fig. 2
ROC curves and cut off scores for H-FABP (HFABP), suPAR, GDF-15 (GDF15) and high sensitive troponin for prediction of ACS in the total cohort
Fig. 3
Fig. 3
ROC curves and cut off scores for sST-2 (blue) and Pro-BNP for prediction of TTS in the total cohort
See this image and copyright information in PMC

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