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

Abstract

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).

Long‐term outcome in patients with Takotsubo syndrome presenting with severely reduced left ventricular ejection fraction

“…Presentation at admission is similar to acute coronary syndrome, but with no evidence of culprit atherosclerotic coronary artery disease at coronary angiography . In this regard, a clinical score to early differentiate acute coronary syndromes from TTS has previously been proposed . TTS aetiology is still unknown, but among the various hypotheses that have been advanced, the most accredited involves catecholamine‐mediated myocardial stunning .…”

Características clínicas y complicaciones del síndrome de Takotsubo en un centro de referencia de la seguridad social peruana

“…El síndrome de Takotsubo en esta serie tiene manifestaciones clínicas, electrocardiográficas y alteraciones en biomarcadores, similares al síndrome coronario agudo; sin embargo, existe una herramienta de ayuda diagnóstica, constituida por siete variables: sexo femenino, presencia de un gatillo emocional y/o físico, desórdenes psiquiátricos y/o neurológicos, intervalo QTc prolongado, y ausencia de depresión del segmento ST. Cada variable tiene un puntaje, y si la sumatoria es mayor o igual a 50 puntos, se tiene una alta probabilidad diagnóstica de síndrome de Takotsubo (12) .…”

Ratio of high-sensitivity troponin to creatine kinase-MB in takotsubo syndrome

“…Desmet et al [22] showed that the presence of an "apical nipple sign" on left ventriculography provided 100% specificity for the diagnosis of TT (in comparison to STEMI patients). More recently, Ghadri et al [23] published the Inter-TAK Diagnostic Score which is based on the largest TT cohort ever published. This score assembles clinical and ECG markers.…”