A novel clinical score (InterTAK Diagnostic Score) to differentiate takotsubo syndrome from acute coronary syndrome: results from the International Takotsubo Registry. (7th December 2016)

• Record Type: Journal Article
• Authors: Ghadri, Jelena R.; Cammann, Victoria L.; Jurisic, Stjepan; Seifert, Burkhardt; Napp, L. Christian; Diekmann, Johanna; Bataiosu, Dana Roxana; D'Ascenzo, Fabrizio; Ding, Katharina J.; Sarcon, Annahita; Kazemian, Elycia; Birri, Tanja; Ruschitzka, Frank; Lüscher, Thomas F.; Templin, Christian
• Other Names: Jaguszewski Milosz investigator.; Franke Jennifer investigator.; Katus Hugo A. investigator.; Burgdorf Christof investigator.; Schunkert Heribert investigator.; Thiele Holger investigator.; Bauersachs Johann investigator.; Tschöpe Carsten investigator.; Rajan Lawrence investigator.; Michels Guido investigator.; Pfister Roman investigator.; Ukena Christian investigator.; Böhm Michael investigator.; Erbel Raimund investigator.; Cuneo Alessandro investigator.; Jacobshagen Claudius investigator.; Hasenfuß Gerd investigator.; Karakas Mahir investigator.; Koenig Wolfgang investigator.; Rottbauer Wolfgang investigator.; Said Samir M. investigator.; Braun‐Dullaeus Ruediger C. investigator.; Cuculi Florim investigator.; Banning Adrian investigator.; Fischer Thomas A. investigator.; Vasankari Tuija investigator.; Airaksinen K.E. Juhani investigator.; Fijalkowski Marcin investigator.; Rynkiewicz Andrzej investigator.; Opolski Grzegorz investigator.; Dworakowski Rafal investigator.; MacCarthy Philip investigator.; Kaiser Christoph investigator.; Osswald Stefan investigator.; Galiuto Leonarda investigator.; Crea Filippo investigator.; Dichtl Wolfgang investigator.; Franz Wolfgang M. investigator.; Empen Klaus investigator.; Felix Stephan B. investigator.; Delmas Clément investigator.; Lairez Olivier investigator.; Erne Paul investigator.; Frantz Stefan investigator.; Prasad Abhiram investigator.; Bax Jeroen J. investigator.;
• Is Part Of: European journal of heart failure. Volume 19:Number 8(2017)
• Page Start: 1036
• Page End: 1042
• Publication Date: 2016-12-07
• Subjects: Takotsubo (stress) syndrome -- Broken heart syndrome -- Acute coronary syndrome -- Clinical score -- Disease prevalence; Heart failure -- Periodicals; Heart Failure -- Periodicals; Insuffisance cardiaque -- Périodiques; Heart failure; Periodicals; 616.129005
• DOI: 10.1002/ejhf.683
• Languages: English
• ISSNs: 1388-9842

Abstract

Abstract : Aims: 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 and results: Patients with TTS were recruited from the International Takotsubo Registry (www.takotsubo‐registry.com ) and ACS patients from the leading hospital in Zurich. A multiple logistic regression for the presence of TTS was performed in a 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 lead aVR) 12, psychiatric disorders 11, neurologic disorders 9, and QTc prolongation 6 points. The area under the curve (AUC) for the resulting score was 0.971 [95% confidence interval (CI) 0.96–0.98] and using a cut‐off value of 40 score points, sensitivity was 89% and specificity 91%. When patients with a score of ≥50 were diagnosed as TTS, nearly 95% of TTS patients were correctly diagnosed. When patients with a score ≤31 were diagnosed as ACS, ∼95% of ACS patients were diagnosed correctly. 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). Conclusion: The InterTAK Diagnostic Score estimates the probability of the presence of TTS and is able to distinguish TTS from ACS with a high sensitivity and specificity. Trial registration: NCT0194762