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. 2022 May 25;11(11):2974.
doi: 10.3390/jcm11112974.

Differential Diagnosis between Takotsubo Syndrome and Acute Coronary Syndrome-A Prospective Analysis of Novel Cardiovascular Biomarkers for a More Selective Triage

Albert Topf  1 , Moritz Mirna  1 , Vera Paar  1 , Lukas J Motloch  1 , Nina Bacher  1 , Marcus Franz  2 , Uta C Hoppe  1 , Daniel Kretzschmar  2 , Michael Lichtenauer  1
Affiliations

Differential Diagnosis between Takotsubo Syndrome and Acute Coronary Syndrome-A Prospective Analysis of Novel Cardiovascular Biomarkers for a More Selective Triage

Albert Topf et al. J Clin Med. .

Abstract

Introduction: Takotsubo syndrome (TTS) is clinically indistinguishable from an ACS. Despite the implementation of clinical scoring systems and novel biomarkers, coronary angiography currently remains necessary for differential diagnosis.

Methods: 93 patients with chest pain and the suspicion of TTS were enrolled in two study centers. Fetuin-A, IGFBP-2, Galectin-3, and TNF α were determined in serum samples, collected within 24 h after the onset of symptoms. Serum levels of biomarkers were analyzed for the differential diagnostic value between TTS and ACS.

Results: Compared to TTS, patients with ACS had significantly lower serum levels of Fetuin-A and IGFBP-2. The cut-off value of Fetuin-A for the identification of TTS compared to ACS was 55.74 μg/mL (sensitivity: 100.0%, specificity: 82.6%, PPV: 63.2%, NPV: 100.0%). An optimal cut-off value for IGFBP-2 for the differential diagnosis between TTS and ACS was determined as 171.77 ng/mL (sensitivity: 76.0%, specificity: 82.6%, PPV: 76.4%, NPV 72.7%).

Conclusion: Fetuin-A and IGFBP-2 might facilitate the triage between TTS and ACS and could be therefore of great benefit for the guidance of treatment.

Keywords: Takotsubo syndrome; acute coronary syndrome; biomarkers.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Comparison of biomarker levels between Takotsubo syndrome (TTC) and ACS patients. (a) TNF α. (b) Galectin-3. (c) Fetuin-A. (d) IGFBP-2.
Figure 2
Figure 2
ROC curves and cut-off scores for IGFBP-2 (IGFBP), TNF α (TNF alpha), Galectin-3 (Galectin), Fetuin-A (fetuina), and high sensitive troponin (hstroponin) for prediction of ACS in the total cohort (including patients with ACS and TTS).
See this image and copyright information in PMC

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