Author + information
- Annahita Sarcona,b,
- Christian Templina,b,
- Thomas F. Luschera,b,
- Jelena Ghadria,b and
- Milosz Jaguszewskia,b
Background: Clinical presentation of takotsubo syndrome (TTS) mimics acute coronary syndrome (ACS) and does not allow differentiation. We aimed to develop a clinical score to estimate the probability of TTS and to distinguish TTS from ACS in the acute stage.
Methods: TTS patients were recruited from the International Takotsubo Registry and ACS patients from the leading hospital Zurich. A multiple logistic regression for the presence of TTS was performed in derivation cohort (TTS, N=218; ACS, N=436). The best model was selected and formed a score (InterTAK Diagnostic Score) with seven variables and each was assigned a score value: female sex 25, emotional trigger 24, physical trigger 13, absence of ST-segment depression (except in aVR)12, psychiatric disorders 11, neurologic disorders 9, and QTc prolongation 6 points. The score was subsequently validated in an independent validation cohort (TTS, N=173; ACS, N=226), resulting in a score AUC of 0.901 (95% CI, 0.87-0.93).
Results: Patients with TTS were mainly females (94.5%) and significantly older than patients with ACS (67.3±13.2 years vs. 63.4±12.1 years, P<0.001). Physical and emotional triggers were more prevalent among the TTS population (P<0.001). The leading symptom on admission was chest pain, however less frequently observed in the TTS group (67.9% vs. 88.3%, P<0.001), while dyspnea was more prevalent among TTS (51.8% vs. 25.2%, P<0.001). ST-segment depression occurred less frequently in the TTS group (10.6% vs. 28.9%, P<0.001) while T-wave inversion was more often noted (35.3% vs. 23.4%, P=0.001). Higher heart rates were found in TTS (87.6 ± 23.0 bpm vs. 73.3 ± 14.8 bpm, P<0.001). Notably, the prevalence of the comorbidities: cancer, COPD/asthma, psychiatric and neurologic disorders were substantially higher in the TTS group.
Conclusions: The InterTAK Diagnostic Score estimates the presence of TTS with high sensitivity and distinguishes TTS from ACS with high specificity. The score can be quickly calculated in the emergency room simply using clinical parameters. Prospective studies under clinical routine conditions are now needed to assess the diagnostic validity of this novel non-invasive test.
Moderated Poster Contributions
Heart Failure and Cardiomyopathies Moderated Poster Theater, Poster Hall, Hall C
Saturday, March 18, 2017, 4:15 p.m.-4:25 p.m.
Session Title: Risky Business: Predicting Outcomes in Heart Failure
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1265M-07
- 2017 American College of Cardiology Foundation