Key result
An NT-proBNP/cTnT ratio >7.5 on the second day of admission differentiated Takotsubo syndrome from acute coronary syndrome with 97.3% sensitivity and 95.4% specificity.
Why the study?
Takotsubo syndrome is typically not diagnosed until coronary angiography shows normal arteries in suspected ACS, prompting exploration into whether cardiac biomarkers can aid early diagnosis.
Does the NT-proBNP/cTnT ratio differentiate Takotsubo syndrome from acute coronary syndrome in patients presenting with suspected ACS?
Observational (n=152)
Does the NT-proBNP/cTnT ratio differentiate Takotsubo syndrome from acute coronary syndrome in patients presenting with suspected ACS?
Absolute Event Rate: 29.6% vs 1.2%
p-value: p=<0.001
An NT-proBNP/cTnT ratio >7.5 on the second day of admission provides high diagnostic accuracy for differentiating Takotsubo syndrome from acute coronary syndrome, particularly NSTEMI.
Cardiac biomarker ratios may aid early TTS differentiation from ACS; leaves open prospective validation before clinical adoption.
Takotsubo syndrome (TTS) is not usually diagnosed until patients with suspected acute coronary syndrome (ACS) and echocardiographically detected apical aneurysm are found to have “normal” coronary angiography (CA). Our aim was to explore whether cardiac biomarkers can contribute to early diagnosis of TTS. Ratios of N-terminal-pro brain natriuretic peptide (NT-proBNP) and high sensitivity cardiac troponin T (cTnT) both expressed in pg/mL [admission and the 3 following days] were compared in 38 patients with TTS and 114 ACS patients of whom 58 had non-ST elevation myocardial infarction (NSTEMI). NT-proBNP/cTnT ratio at admission and during the following 3 days was significantly higher in TTS compared to ACS patients [18.4 (8.7-41.7) vs 2.9 (0.8-6.8), 29.6 (14.3-53.7) vs 1.2 (0.5-2.7), 30.0 (11.6-50.9) vs 1.7 (0.5-3.0), 27.8 (11.3-42.6) vs 1.4 (0.6-2.8), respectively, all <0.001]. Βest discrimination of TTS from ACS was possible with the ratio of NT-proBNP/cTnT on the 2nd day. A cut-off value of NT-proBNP/cTnT ratio >7.5 had a sensitivity of 97.3%, a specificity of 95.4% and an accuracy of ∼96% in detecting TTS as opposed to ACS. Furthermore, the ratio of NT-proBNP/cTnT preserved its discriminatory value in the subgroup of NSTEMI patients. In particular, a NT-proBNP/cTnT ratio >7.5 on the 2nd day had a sensitivity of 97.3%, a specificity of 91.4% and an accuracy of 93.7% in differentiating TTS from NSTEMI. An NT-proBNP/cTnT ratio >7.5 on the 2nd day of admission can be useful for the early identification of TTS among selected patients initially presenting with ACS, a ratio more clinically useful in the setting of NSTEMI.
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Rallidis et al. (2023) conducted an observational in Takotsubo syndrome and Acute Coronary Syndrome (n=152). NT-proBNP/cTnT ratio vs. Acute coronary syndrome patients was evaluated on NT-proBNP/cTnT ratio on the 2nd day of admission (p=<0.001). An NT-proBNP/cTnT ratio >7.5 on the second day of admission differentiated Takotsubo syndrome from acute coronary syndrome with 97.3% sensitivity and 95.4% specificity.
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