Evaluation of the InterTAK Diagnostic Score in differentiating Takotsubo syndrome from acute coronary syndrome. A single center experience
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Abstract
Background: The aim of this study was to evaluate the usefulness of a novel clinical score — the InterTAK Diagnostic Score in differentiating Takotsubo syndrome (TTS) from acute coronary syndrome (ACS).
Methods: Medical records of 40 consecutive patients with ACS and 20 patients with TTS were managed and retrospectively analyzed at the documented center. Each patient was evaluated using the Inter- TAK Diagnostic Score. To illustrate the diagnostic ability of the score, a receiver operating characteristic (ROC) curve was performed.
Results: Takotsube syndrome patients were more often female compared to the ACS group (70% vs. 27.5%, p = 0.002), an emotional trigger was more prevalent among the TTS group (65% vs. 7.5%, p < 0.001). The area under the curve (AUC) for the score was 0.885 (95% confidence interval [CI] 0.78–0.97). Using a cut-off value of 45 points, the sum of sensitivity and specificity was the highest. However, when patients with a score of ≥ 50 were diagnosed as TTS, 85% were diagnosed correctly. When patients with score ≤ 31 were diagnosed as ACS, 92% were diagnosed correctly.
Conclusions: The InterTAK Diagnostic Score might help in differentiating TTS from ACSs with high sensitivity and specificity. This finding requires further investigation to confirm its clinical utility.
Keywords: Takotsubo syndromebroken heart syndromeacute coronary syndromeclinical score
References
- Ghadri JR, Wittstein IS, Prasad A, et al. International Expert Consensus Document on Takotsubo Syndrome (Part I): Clinical Characteristics, Diagnostic Criteria, and Pathophysiology. Eur Heart J. 2018; 39(22): 2032–2046.
- Ghadri JR, Wittstein IS, Prasad A, et al. International Expert Consensus Document on Takotsubo Syndrome (Part II): Diagnostic Workup, Outcome, and Management. Eur Heart J. 2018; 39(22): 2047–2062.
- Ghadri JR, Cammann VL, Napp LC, et al. International Takotsubo (InterTAK) Registry. Differences in the Clinical Profile and Outcomes of Typical and Atypical Takotsubo Syndrome: Data From the International Takotsubo Registry. JAMA Cardiol. 2016; 1(3): 335–340.
- Sharkey SW, Lesser JR, Maron MS, et al. Why not just call it tako-tsubo cardiomyopathy: a discussion of nomenclature. J Am Coll Cardiol. 2011; 57(13): 1496–1497.
- Templin C, Ghadri JR, Diekmann J, et al. Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy. N Engl J Med. 2015; 373(10): 929–938.
- Kato K, Lyon AR, Ghadri JR, et al. Takotsubo syndrome: aetiology, presentation and treatment. Heart. 2017; 103(18): 1461–1469.
- Di Vece D, Citro R, Cammann VL, et al. Outcomes Associated With Cardiogenic Shock in Takotsubo Syndrome. Circulation. 2019; 139(3): 413–415.
- Frangieh AH, Obeid S, Ghadri JR, et al. InterTAK Collaborators. ECG Criteria to Differentiate Between Takotsubo (Stress) Cardiomyopathy and Myocardial Infarction. J Am Heart Assoc. 2016; 5(6).
- Opolski G, Pawlak MM, Roik MF, et al. Clinical presentation, treatment, and long-term outcomes in patients with takotsubo cardiomyopathy. Experience of a single cardiology center. Pol Arch Med Wewn. 2010; 120(6): 231–236.
- Pawlak M, Roik M, Kochanowski J, et al. Comparison of on-admission ST-segment elevation tako-tsubo patients and myocardial infarction women: in-hospital course and long-term follow-up. Kardiol Pol. 2012; 70(3): 233–240.
- Prasad A, Lerman A, Rihal CS. Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction. Am Heart J. 2008; 155(3): 408–417.
- Deshmukh A, Kumar G, Pant S, et al. Prevalence of Takotsubo cardiomyopathy in the United States. Am Heart J. 2012; 164(1): 66–71.e1.
- Schneider B, Athanasiadis A, Stöllberger C, et al. Gender differences in the manifestation of tako-tsubo cardiomyopathy. Int J Cardiol. 2013; 166(3): 584–588.
- Roshanzamir S, Showkathali R. Takotsubo cardiomyopathy a short review. Curr Cardiol Rev. 2013; 9(3): 191–196.
- Dias A, Núñez Gil IJ, Santoro F, et al. Takotsubo syndrome: State-of-the-art review by an expert panel - Part 1. Cardiovasc Revasc Med. 2019; 20(1): 70–79.
- Kochanowski J, Piatkowski R, Budnik M, et al. Biventricular takotsubo cardiomyopathy in an elderly woman with uncontrolled type 2 diabetes: the biphasic echocardiographic and clinical pattern. Acta Diabetol. 2016; 53(6): 1061–1063.
- Ghadri JR, Cammann VL, Jurisic S, et al. A novel clinical score (InterTAK Diagnostic Score) to differentiate takotsubo syndrome from acute coronary syndrome: results from the International Takotsubo Registry. Eur J Heart Fail. 2017; 19(8): 1036–1042.
- Ibanez B, James S, Agewall S, et al. ESC Scientific Document Group. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018; 39(2): 119–177.
- Roffi M, Patrono C, Collet JP, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016; 37(3): 267–315.
- Sharkey SW, Windenburg DC, Lesser JR, et al. Natural history and expansive clinical profile of stress (tako-tsubo) cardiomyopathy. J Am Coll Cardiol. 2010; 55(4): 333–341.
- Ghadri JR, Kato K, Cammann VL, et al. Long-Term Prognosis of Patients With Takotsubo Syndrome. J Am Coll Cardiol. 2018; 72(8): 874–882.
- Dias A, Núñez Gil IJ, Santoro F, et al. Takotsubo syndrome: State-of-the-art review by an expert panel - Part 2. Cardiovasc Revasc Med. 2019; 20(2): 153–166.
- Di Vece D, Citro R, Templin C, et al. Outcomes Associated With Cardiogenic Shock in Takotsubo Syndrome. Circulation. 2019; 139(3): 413–415.
- Gili S, Cammann VL, Schlossbauer SA, et al. Cardiac arrest in takotsubo syndrome: results from the InterTAK Registry. Eur Heart J. 2019; 40(26): 2142–2151.
- Abe Y, Kondo M, Matsuoka R, et al. Assessment of clinical features in transient left ventricular apical ballooning. J Am Coll Cardiol. 2003; 41(5): 737–742.
- Ghadri JR, Sarcon A, Diekmann J, et al. InterTAK Co-investigators:. Happy heart syndrome: role of positive emotional stress in takotsubo syndrome. Eur Heart J. 2016; 37(37): 2823–2829.
