ABSTRACT
BACKGROUND: Takotsubo syndrome (TTS) is a clinical condition that mimics acute myocardial infarction (MI). More than 90% patients are women, mainly postmenopausal. Research suggests that up to 5% of women evaluated for a MI actually have TTS and that diagnose may be underestimated. Patients with TTS are generally able to fully recover within a period of days to weeks. However, serious, potentially fatal, complications may occur. METHODS: In 117 consecutive female patients hospitalized with TTS and 117 consecutive female patients with ST-segment elevation MI, we collected data regarding cardiovascular risk factors, comorbidities, and complications. We compared all in-hospital complications in both groups and analyzed factors influencing the composite endpoint which was cardiogenic shock and death from any cause. RESULTS: In our study patients with TTS had a lower incidence of serious complications compared to the ST-segment elevation MI group. Moreover, in-hospital mortality was also lower in the TTS group. The factors which influenced cardiogenic shock and death from any cause were: heart rate at admission, diastolic blood pressure at admission, C-reactive protein (CRP) concentration at admission, chest pain at admission, ST-segment depression in the electrocardiography at admission, and ejection fraction at admission. Moreover, patients with exacerbation of chronic disease as the cause of TTS also reached the composite endpoint more often. CONCLUSIONS: Female patients with TTS had more favorable in-hospital prognoses than patients with ST-segment elevation MI. However, serious complications occurred. The factors which influenced the composite endpoint came from readily available data-within the first hour after admission to the hospital.
Subject(s)
Heart Rate/physiology , Hospital Mortality , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/mortality , Shock, Cardiogenic/mortality , Takotsubo Cardiomyopathy/diagnosis , Takotsubo Cardiomyopathy/mortality , Aged , Blood Pressure , C-Reactive Protein/metabolism , Electrocardiography , Female , Humans , Hypertension/epidemiology , Incidence , Middle Aged , Poland/epidemiology , Shock, Cardiogenic/complications , Shock, Cardiogenic/therapy , Smoking/epidemiology , Takotsubo Cardiomyopathy/therapyABSTRACT
BACKGROUND: Takotsubo cardiomyopathy (TTC) is a clinical condition mimicking acute myocardial infarction. A specific biomarker for TTC screening is required, but until now, no single biomarker has been established for the early diagnosis of TTC and differentiation from ST-segment elevation myocardial infarction (STEMI). In our study we focused on the simple markers that are available in every hospital. METHODS: In 66 consecutive patients (pts) who were hospitalized with TTC and 66 pts with STEMI, cardiac biomarkers, such as NT-proBNP, TnI, CK and CKMB mass were determined during 12h from admission and compared with demographic, clinical and echocardiographic findings. RESULTS: The concentration of NTproBNP was greater in pts with TTC than STEMI (4702pg/ml vs 2138pg/ml). The concentration of TnI and CKMB mass was greater in the STEMI group than in the TTC group (TnI: 2.1ng/ml and CK MB mass: 9.5ng/ml in pts with TTC vs TnI: 19ng/ml and CK MB mass: 73.3ng/ml in pts with STEMI). The NTproBNP/TnI ratio and NTproBNP/CKMB mass ratio were, respectively, 2235.2 and 678.2 in pts with TTC and 81.6 and 27.5 in pts with STEMI (p<0.001). Moreover, the NTproBNP/EF ratio was also statistically significant (110.4 in TTC group and 39.4 in STEMI group). CONCLUSIONS: NTproBNP/TnI, NTproBNP/CKMB mass and NTproBNP/EF ratios can distinguish TTC from STEMI at an early stadium. The most accurate marker is the NTproBNP/TnI ratio.
