Key result
TIMP-1 levels differentiated takotsubo cardiomyopathy from acute coronary syndrome better than troponin T, with an AUC of 0.679.
Why the study?
Does serum TIMP-1 measurement improve the differentiation of Takotsubo cardiomyopathy from acute coronary syndrome compared to Troponin T?
Observational (n=3,117)
No
Does serum TIMP-1 measurement improve the differentiation of Takotsubo cardiomyopathy from acute coronary syndrome compared to Troponin T?
Effect estimate: AUC 0.679 (95% CI 0.606-0.753)
Absolute Event Rate: 115.7% vs 146.7%
p-value: p=<0.0001
Serum TIMP-1 levels can help differentiate Takotsubo cardiomyopathy from acute coronary syndrome better than Troponin T, and a low MMP-8/TIMP-1 ratio may reflect left ventricular impairment in TTC.
May support TIMP-1 for differentiating takotsubo cardiomyopathy from ACS; leaves open prospective validation before clinical adoption.
BACKGROUND: Matrix metalloproteinase 8 (MMP-8) is the most potent type-I collagen protease. Such collagen mainly constitutes the transient fibrosis in takotsubo cardiomyopathy (TTC) endomyocardial biopsies. High MMP-8 and tissue-inhibitor of matrix metalloproteinase-1 (TIMP-1) levels are implicated in acute coronary syndrome (ACS). We compared MMP-8 and TIMP-1 levels in consecutive TTC and ACS patients, and their association to TTC severity. METHODS AND RESULTS: In 45 acute serum samples of TTC, 2072 ACS and 1000 controls, TIMP-1 differed between ACS 146.7ng/mL (115.0-186.3) (median (interquartile range)), TTC 115.7 (94.3-137.7) and controls 80.9 (73.2-90.4), (p<0.0001). MMP-8 levels were similar between ACS and TTC. In receiver-operating characteristics analysis, TIMP-1 differentiated TTC from ACS with an area under the curve (AUC) of 0.679 (p<0.0001) surpassing troponin T (TnT) at 0.522 (p = 0.66). Compared to other differing factors (age, sex, smoking), TIMP-1 improved diagnostic specificity and sensitivity from AUC of 0.821 to 0.844 (p = 0.007). The MMP8/TIMP-1 molar ratio differentiated normal ejection fraction (EF) at 0.27 (0.13-0.51) from decreased EF<50% at 0.08 (0.05-0.20), (p = 0.04) in TTC, but not in ACS. CONCLUSIONS: Even with other differing factors considered, TIMP-1 differentiated TTC from ACS better than TnT. In TTC, the low MMP-8/TIMP-1 molar ratio may reflect decreased proteolysis and increased transient fibrosis, perhaps in part explaining the left-ventricle impairment.
No takes yet. Share an insight, caveat, or question.
Parkkonen et al. (2017) conducted an observational in Takotsubo cardiomyopathy and acute coronary syndrome (n=3,117). TIMP-1 and MMP-8 levels vs. Acute coronary syndrome vs Takotsubo cardiomyopathy was evaluated on Differentiation of TTC from ACS using TIMP-1 (AUC 0.679, 95% CI 0.606-0.753, p=<0.0001). TIMP-1 levels differentiated takotsubo cardiomyopathy from acute coronary syndrome better than troponin T, with an AUC of 0.679.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: