Serum copeptin/NT-proBNP ratio: A more reliable index of absolute endogenous stress and prognosis during the course of Tako-tsubo cardiomyopathy?

Takotsubo cardiomyopathy: Pathophysiology and role of cardiac biomarkers in differential diagnosis

“…Several markers including Copeptin[13], lipid profile[14], sLOX-1[15], IMA[16], sST-2[17] have been proposed for differentiating TC from ACS. High HDL-C and lower levels of LDL and triglycerides have been reported in TC compared to MI[14].…”

Microvascular dysfunction in Takotsubo cardiomyopathy: Prognostic implications

“…Yalta and associates provide valuable insights into the prognostic implications of microvascular dysfunction associated with Takotsubo cardiomyopathy [1]. They describe the utility of prognostic markers such as copeptin/N-terminal fragment (NTproBNP) ratio, prolonged corrected QT (Qtc) interval and neuropeptide-Y in predicting adverse outcomes such as acute left ventricular systolic and diastolic dysfunction, myocardial stunning, cardiovascular arrest, and malignant ventricular arrhythmias in these patients [1,8]. A prolonged TIMI frame count is possibly another important diagnostic marker for an indirect assessment of microvascular function in TTC patients [2,3].…”

Coronary slow flow in the setting of Tako-tsubo cardiomyopathy: A causative factor? An innocent bystander? Or a prognostic sign?

“…The presence of clinical heart failure and a variety of indices including ratio of copeptin/NT-pro BNP have been suggested to have a prognostic value in patients with TTC [7]. More recently, it was suggested that coronary vasospasm might not only account for myocardial standstill (characteristic for TTC) but might also induce malign ventricular arrhythmias associated with cardiovascular arrest in patients with TTC [8].…”

“…As another prognostic index, corrected QT interval (QTc) prolongation on electrocardiogram (ECG) (a well known parameter of sympathetic discharge) was also shown to be associated with cardiovascular arrest due to induction of polymorphic ventricular tachycardia (PVT) during the early course of TTC (particularly within the first few days) [9]. Taken together, a variety of prognostic indices have been proposed in the setting of TTC [5][6][7][8][9]. However, combined use of these indices (not a single marker) might help better risk stratification and management of patients with TTC.…”