Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio.
Director Resident Research, Fairview Hospital - Cleveland Clinic, Clinical Professor of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio.
J Card Fail. 2014 Jan;20(1):2-8. doi: 10.1016/j.cardfail.2013.12.004. Epub 2013 Dec 14.
Takotsubo cardiomyopathy (TC) mimics acute myocardial infarction (AMI). We postulated that ventricular dysfunction in TC in the absence of significant myocardial necrosis would produce higher B-type natriuretic peptide (BNP)/troponin T (TnT) and BNP/creatine kinase MB fraction (CKMB) ratios than in AMI.
We studied 58 consecutive TC (age 65.8 ± 82.9) and 97 AMI patients (age 59.8 ± 83.4). The ratios of BNP/TnT and BNP/CKMB were calculated with the use of first simultaneously drawn laboratory values. Receiver operating characteristic curves were used to distinguish TC from AMI with 95% specificity based on cardiac biomarker ratios. Median BNP/TnT and BNP/CKMB ratios were, respectively, 1,292 [interquartile range 443.4-2,657.9] and 28.44 [13.7-94.8] in the TC group and 226.9 [69.91-426.32] and 3.63 [1.07-10.02] in the AMI group (P < .001). TC can be distinguished from AMI with 95% specificity with the use of BNP/TnT ratio ≥ 1,272 (sensitivity 52%) and BNP/CKMB ratio ≥ 29.9 (sensitivity 50%).
The value of BNP is significantly higher in TC than in AMI. Early BNP/TnT and BNP/CKMB ratios help to differentiate TC from AMI with greater accuracy than BNP alone.
心尖球囊样综合征（TC）类似于急性心肌梗死（AMI）。我们推测，在没有明显心肌坏死的情况下，TC 导致的心室功能障碍会产生更高的 B 型利钠肽（BNP）/肌钙蛋白 T（TnT）和 BNP/肌酸激酶 MB 片段（CKMB）比值，高于 AMI。
我们研究了 58 例连续 TC（年龄 65.8 ± 82.9）和 97 例 AMI 患者（年龄 59.8 ± 83.4）。使用首次同时抽取的实验室值计算 BNP/TnT 和 BNP/CKMB 比值。使用受试者工作特征曲线区分 TC 和 AMI，基于心脏生物标志物比值的特异性为 95%。TC 组的 BNP/TnT 和 BNP/CKMB 比值中位数分别为 1292[四分位距 443.4-2657.9]和 28.44[13.7-94.8]，AMI 组分别为 226.9[69.91-426.32]和 3.63[1.07-10.02]（P<0.001）。使用 BNP/TnT 比值≥1272（敏感性 52%）和 BNP/CKMB 比值≥29.9（敏感性 50%），TC 可与 AMI 以 95%特异性区分。
BNP 在 TC 中的值明显高于 AMI。早期 BNP/TnT 和 BNP/CKMB 比值比单独使用 BNP 更能准确地区分 TC 和 AMI。
