The differential diagnostic value of selected cardiovascular biomarkers in Takotsubo syndrome,Clinical Research in Cardiology

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The differential diagnostic value of selected cardiovascular biomarkers in Takotsubo syndrome
Clinical Research in Cardiology ( IF 3.8 ) Pub Date : 2021-11-02 , DOI: 10.1007/s00392-021-01956-2
Albert Topf ₁ , Moritz Mirna ₁ , Vera Paar ₁ , Lukas J Motloch ₁ , Janine Grueninger ₁ , Christiane Dienhart ₂ , Paul C Schulze ₃ , Mathias C Brandt ₁ , Robert Larbig ₄ , Uta C Hoppe ₁ , Daniel Kretzschmar ₃ , Michael Lichtenauer ₁

Affiliation

Introduction

Takotsubo syndrome (TTS) is clinically indistinguishable from an acute coronary syndrome (ACS). In the absence of valid markers for differential diagnosis, coronary angiography has been indispensable.

Methods

In our study, we evaluated the serum levels of sST-2, GDF-15, suPAR and H-FABP in 92 patients with the suspicion of TTS (51 TTS and 41 ACS patients) and 40 gender matched controls (no coronary artery disease or signs of heart failure) at baseline.

Results

H-FABP was significantly higher in ACS patients compared to TTS patients. Even in in propensity score matching for left ventricular ejection fraction, sex and cardiovascular risk factors, differences in the plasma levels of H-FABP in the matched cohort of TTS vs ACS remained statistically significant. Whereas, sST-2 was significantly elevated in TTS patients. H-FABP was superior for prediction of an ACS with even higher accuracy than hs troponin in differential diagnosis (AUC 0.797, p ≤ 0.0001); the optimal cut off for discrimination towards a TTS was calculated as 2.93 ng/ml (sensitivity 70.0%, specificity 82.4%, PPV 75.7%, NPV 77.4%). sST-2 seemed most appropriate for identification of a TTS (AUC 0.653, p = 0.012). The optimal cut off for differential diagnosis was 11018.06 pg/ml (sensitivity 82.0%, specificity 51.2%, PPV 69.4%, NPV 71.9 %).

Conclusion

H-FABP and sST-2 are the most promising markers with better accuracy than preexisting biomarkers in differential diagnosis in our study and therefore, could be crucial for the guidance of treatment in patients with high bleeding risk, advanced renal failure or multimorbidity.

Graphical abstract

中文翻译：

选定的心血管生物标志物对 Takotsubo 综合征的鉴别诊断价值

介绍

Takotsubo 综合征 (TTS) 在临床上与急性冠状动脉综合征 (ACS) 无法区分。在缺乏有效鉴别诊断标志物的情况下，冠状动脉造影是必不可少的。

方法

在我们的研究中，我们评估了 92 名疑似 TTS 患者（51 名 TTS 和 41 名 ACS 患者）和 40 名性别匹配对照者（无冠状动脉疾病或患有冠心病）的 sST-2、GDF-15、suPAR 和 H-FABP 血清水平。心力衰竭的迹象）在基线。

结果

与 TTS 患者相比，ACS 患者的 H-FABP 显着较高。即使在左心室射血分数、性别和心血管危险因素的倾向评分匹配中，TTS 与 ACS 匹配队列中血浆 H-FABP 水平的差异仍然具有统计学显着性。而 TTS 患者的 sST-2 显着升高。在鉴别诊断中，H-FABP 在预测 ACS 方面优于 hs 肌钙蛋白，准确度甚至更高（AUC 0.797， p ≤ 0.0001）； TTS 歧视的最佳截止值计算为 2.93 ng/ml（敏感性 70.0%，特异性 82.4%，PPV 75.7%，NPV 77.4%）。 sST-2 似乎最适合识别 TTS（AUC 0.653， p = 0.012）。鉴别诊断的最佳临界值为 11018.06 pg/ml（敏感性 82.0%，特异性 51.2%，PPV 69.4%，NPV 71.9%）。