Value of Cardiac Biomarkers in the Early Diagnosis of Takotsubo Syndrome
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Population
2.2. Clinical Assessment
2.3. Outcomes
2.4. Statistical Analysis
3. Results
3.1. Baseline Characteristics of the Whole Cohort
3.2. Propensity Score Matching (Supplementary Files)
3.3. Outcomes
3.4. Value of the BNP and the Troponin I Kinetics in the Differential Diagnosis between TTS, STEMI, and NSTEMI
3.5. Value of the BNP/Troponin Ratio in the Differential Diagnosis between TTS, STEMI, and NSTEMI
3.6. Value of the BNP/Troponin Ratio in the Differential Diagnosis between TTS and STEMI
3.7. Value of the BNP/Troponin Ratio in the Differential Diagnosis between TTS and NSTEMI
3.8. Diagnostic Scores for TTS and STEMI Distinction
3.9. Diagnostic Scores for TTS and NSTEMI Distinction
4. Discussion
Study Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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TTS Patients (n = 314) | STEMI Patients (n = 452) | NSTEMI Patients (n = 334) | p Value | p Value STEMI vs. TTS | p Value NSTEMI vs. TTS | p Value STEMI vs. NSTEMI | |
---|---|---|---|---|---|---|---|
Demographics | |||||||
Age | 70.7 ± 13.4 | 62.1 ± 13.8 | 67.9 ± 13.9 | <0.001 | <0.001 | 0.024 | <0.001 |
Female gender, n (%) | 257 (81.8) | 106 (23.4) | 81 (24.2) | <0.001 | <0.001 | <0.001 | 1 |
CVD risk factors | |||||||
Hypertension, n (%) | 180 (57.3) | 229 (50.7) | 234 (70.1) | <0.001 | 0.232 | 0.002 | <0.001 |
Diabetes mellitus, n (%) | 65 (20.7) | 94 (20.8) | 96 (28.7) | 0.016 | 1 | 0.055 | 0.034 |
Dyslipidemia, n (%) | 127 (40.5) | 185 (40.9) | 185 (55.4) | <0.001 | 1 | <0.001 | <0.001 |
Current tobacco use, n (%) | 59 (18.8) | 208 (46) | 103 (30.8) | <0.001 | <0.001 | 0.001 | <0.001 |
Past tobacco use, n (%) | 67 (21.3) | 119 (26.3) | 105 (31.4) | 0.014 | 0.370 | 0.013 | 0.387 |
Background | |||||||
History of malignancy, n (%) | 82 (26.1) | 31 (6.9) | 23 (6.9) | <0.001 | <0.001 | <0.001 | 1 |
History of psychiatric disease, n (%) | 95 (30.4) | 10 (2.2) | 6 (1.8) | <0.001 | <0.001 | <0.001 | 1 |
History of AF, n (%) | 50 (15.9) | 22 (4.9) | 39 (11.7) | <0.001 | <0.001 | 0.413 | 0.019 |
History of stroke, n (%) | 32 (10.2) | 31 (6.9) | 43 (12.9) | 0.017 | 0.328 | 0.978 | 0.019 |
History of PAD or ischemic heart disease, n (%) | 70 (22.4) | 77 (17.0) | 105 (31.4) | <0.001 | 0.228 | 0.031 | <0.001 |
Chronic kidney disease, n (%) | <0.001 | 0.63 | <0.001 | 0.04 | |||
moderate (DFG 30–60) | 70 (22.3) | 49 (10.8) | 53 (15.9) | ||||
severe (15–30) | 11 (3.5) | 12 (2.6) | 9 (2.7) | ||||
terminal (<15) | 9 (2.9) | 3 (0.7) | 2 (0.6) | ||||
Hemodynamic parameters | |||||||
Heart rate, bpm | 90.2 ± 23 | 77.5 ± 15.6 | 76 ± 21 | <0.001 | <0.001 | <0.001 | 1 |
SBP, mmHg | 126.1 ± 28 | 128.6 ± 22 | 143.8 ± 28.1 | <0.001 | <0.001 | <0.001 | 1 |
Electrocardiogram at admission | |||||||
Q wave, n (%) | 163 (52.8) | 96 (47.3) | 6 (1.9) | <0.001 | 0.723 | <0.001 | <0.001 |
Echocardiography | |||||||
LVEF at admission, % | 38.5 ± 12 | 50 ± 11.2 | 54.1 ± 11.2 | <0.001 | <0.001 | <0.001 | <0.001 |
RV involvement, n (%) | 15 (5.1) | 48 (10.6) | 10 (3) | <0.001 | 0.029 | 0.659 | <0.001 |
Biology at admission | |||||||
Tn I, ng/L | 1 [2.7] | 1.3 [12] | 0.4 [1.5] | <0.001 | <0.001 | 1 | <0.001 |
BNP, ng/mL | 427.5 [967] | 70 [183.2] | 99.5 [199] | <0.001 | <0.001 | <0.001 | 0.445 |
CRP, mg/L | 13 [50.9] | 3 [9.7] | 3 [8.8] | <0.001 | <0.001 | <0.001 | 0.404 |
Leukocytes, G/L | 12.1 ± 5.8 | 12 ± 4 | 9.8 ± 4.7 | <0.001 | 0.886 | <0.001 | <0.001 |
Hemoglobin, g/dL | 12.8 ± 2.7 | 14.1 ± 1.8 | 13.9 ± 1.8 | <0.001 | <0.001 | <0.001 | 0.138 |
Creatinine serum μmol/L | 68 [38.5] | 73.8 [25] | 76 [27.5] | 0.437 | - | - | - |
GFR, mL/min/m2 | 73.9 ± 27.9 | 80.8 ± 17.8 | 77.6 ± 18.8 | <0.001 | <0.001 | 0.073 | 0.091 |
Plasma sodium level, mmol/L | 137.4 ± 4.7 | 137.5 ± 3 | 138.2 ± 3.2 | 0.005 | 0.952 | 0.012 | 0.014 |
TTS Patients (n= 314) | STEMI Patients (n= 452) | NSTEMI Patients (n= 334) | p Value | p Value STEMI vs. TTS | p Value NSTEMI vs. TTS | p Value STEMI vs. NSTEMI | |
---|---|---|---|---|---|---|---|
In-hospital events | |||||||
Cardiogenic shock, n (%) | 44 (14) | 14 (3.1) | 1 (0.3) | <0.001 | <0.001 | <0.001 | 0.009 |
SVT, n (%) | 78 (24.4) | 12 (2.6) | 10 (3) | <0.001 | <0.001 | <0.001 | 1 |
Sustained VT, n (%) | 4 (1.3) | 1 (0.2) | 1 (0.3) | 0.115 | - | - | - |
VF, n (%) | 3 (1.0) | 2 (0.4) | 2 (0.6) | 0.110 | - | - | - |
Torsade de Pointe, n (%) | 2 (0.6) | 0 (0) | 0 (0) | 0.081 | - | - | - |
3-degree AV block, n (%) | 2 (0.6) | 8 (1.8) | 1 (0.3) | 0.092 | - | - | - |
In hospital mortality, n (%) | 23 (7.3) | 9 (2) | 6 (1.8) | <0.001 | 0.001 | 0.003 | 1 |
Hospital length of stay, n (days) | 8.0 [7.0] | 5.0 [5.0] | 4.0 [5.0] | 0.511 | <0.001 | <0.001 | 1 |
Follow up events | |||||||
Hospitalization for acute HF, n (%) | 33 (10.8) | 25 (5.8) | 17 (5.4) | 0.019 | 0.337 | 0.042 | 1 |
30-day mortality, n (%) | 20 (6.7) | 12 (2.7) | 8 (2.4) | 0.005 | 0.027 | 0.033 | 1 |
1-year mortality, n (%) | 43 (16.3) | 21 (4.7) | 22 (6.6) | <0.001 | <0.001 | <0.001 | 0.804 |
1-year CV mortality, n (%) | 15 (5.1) | 12 (2.7) | 9 (2.7) | 0.149 | - | - | - |
Cut-Off Value | Se | Sp | NPV | PPV | AUC, (%) | 95% Confidence Interval, (%) | |
---|---|---|---|---|---|---|---|
TTS vs. STEMI | |||||||
BNP/Tn I at admission | 68.25 | 0.8216 | 0.6371 | 0.8395 | 0.6071 | 79.9 | (76.5–83.3) |
Peak BNP/peak TnI | 39.25 | 0.8810 | 0.9362 | 0.9188 | 0.9056 | 96.0 | (94.6–97.3) |
Diagnostic score | 0.3851 | 0.8788 | 0.8386 | 0.9158 | 0.7759 | 92.6 | (90.7–94.5) |
Simplified diagnostic score | 43 | 0.9242 | 0.7735 | 0.9413 | 0.7219 | 93.3 | (91.5–95.1) |
TTS vs. NSTEMI | |||||||
BNP/TnI at admission | 196.25 | 0.658 | 0.5589 | 0.6434 | 0.5747 | 61.9 | (57.2–66.5) |
Peak BNP/peak TnI | 76.5 | 0.7857 | 0.6578 | 0.7586 | 0.6916 | 75.8 | (71.9–79.6) |
Diagnostic score | 0.4406 | 0.8951 | 0.8513 | 0.8936 | 0.8533 | 93.8 | (92.0–95.7) |
Simplified diagnostic score | 42 | 0.8192 | 0.9138 | 0.8494 | 0.8950 | 92.4 | (90.2–94.5) |
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Dagrenat, C.; Von Hunolstein, J.J.; Matsushita, K.; Thebaud, L.; Greciano, S.; Tuzin, N.; Meyer, N.; Trinh, A.; Jesel, L.; Ohlmann, P.; et al. Value of Cardiac Biomarkers in the Early Diagnosis of Takotsubo Syndrome. J. Clin. Med. 2020, 9, 2985. https://doi.org/10.3390/jcm9092985
Dagrenat C, Von Hunolstein JJ, Matsushita K, Thebaud L, Greciano S, Tuzin N, Meyer N, Trinh A, Jesel L, Ohlmann P, et al. Value of Cardiac Biomarkers in the Early Diagnosis of Takotsubo Syndrome. Journal of Clinical Medicine. 2020; 9(9):2985. https://doi.org/10.3390/jcm9092985
Chicago/Turabian StyleDagrenat, Charlotte, Jean Jacques Von Hunolstein, Kensuke Matsushita, Lucie Thebaud, Stéphane Greciano, Nicolas Tuzin, Nicolas Meyer, Annie Trinh, Laurence Jesel, Patrick Ohlmann, and et al. 2020. "Value of Cardiac Biomarkers in the Early Diagnosis of Takotsubo Syndrome" Journal of Clinical Medicine 9, no. 9: 2985. https://doi.org/10.3390/jcm9092985