Researchers have created a tool that can diagnose Takotsubo syndrome - otherwise known as 'broken heart syndrome' - that may avoid unnecessary invasive procedures in some patients.
Takotsubo syndrome is an acute heart condition that primarily affects postmenopausal women and is often triggered by severe emotional or physical stress. It accounts for around 4% of all patients with a suspected heart attack, and one in ten women who experience sudden reduced blood flow to the heart, known as acute coronary syndrome.
Takoutsubo syndrome and a heart attack share many of the same symptoms - including sudden chest pain, electrocardiographic changes and elevated cardiac enzymes - making it difficult to distinguish between them. Unlike with a heart attack, Takotsubo syndrome does not involve blocked arteries. However, doctors still need to perform invasive cardiac catheterisation to check their arteries and confirm they are not experiencing a heart attack.
An international research team, co-led by Professor Thomas F. Lüscher, Adjunct Lecturer at King's College London, has now developed and validated a simple diagnostic score that can identify Takotsubo syndrome before catheterisation.
Our study shows that a simple combination of blood biomarkers and sex can identify patients with remarkable accuracy before cardiac catheterisation."
Co-first author Florian A. Wenzl of the Center for Molecular Cardiology at the University of Zurich and the Radcliffe Department of Medicine at the University of Oxford
By capturing pathways involved in stress responses, cardiac dysfunction and plaque stability, the BioTAK score translates complex disease mechanisms into a practical diagnostic tool."
Co-senior Professor Thomas F. Lüscher, Adjunct Lecturer at King's College London and the Royal Brompton and Harefield Hospitals
The researchers studied 3,165 patients with either acute coronary syndrome or Takotsubo syndrome. Roughly half were used to develop the diagnostic tool, while the other half were used to independently test whether it worked.
They measured a range of cardiovascular biomarkers in blood samples taken before catheterisation. They then used machine learning to identify the most useful variables to create a five-item diagnostic score called BioTAK, utilising information relating to heart stress, anxiety regulation, atherosclerotic plaque instability, sex, and more.
BioTAK was revealed to be a highly accurate scoring system for determining who had acute coronary syndrome and Takotsubo. Using predefined thresholds, the score could correctly classify almost 90% of patients before catheterisation.
The researchers believe the BioTAK score could be a valuable addition to the early emergency assessment of patients with suspected acute coronary syndrome. While it does not replace cardiac catheterisation when there is strong medical evidence the procedure is required, it could help to guide diagnostic pathways more selectively and avoid unnecessary invasive procedures in some patients.
Future studies will now determine whether integrating the BioTAK score into routine clinical practice can further improve the diagnosis and management of patients with Takotsubo syndrome.
The study was led by a team involving close collaboration between researchers at the Universities of Zurich and Greifswald.
