Background: Takotsubo syndrome [TTS] at presentation, raises significant questions of differential diagnosis.
Objectives: To develop an algorithm todistinguish TTS from acute myocardial infarction [MI] , based on comorbidities and conditions at presentation, derived from MIDAS, a New Jersey statewide database.
Methods: International classification of diseases-9 [ICD-9] codes as primary admission diagnoses were: for TTS 429.83 [747 patients] and for acute anterolateral wall MI [ALWMI ] 410.01 [4118 patients].
Six clinical characteristics were identified: mitral valve disorder, disorders of magnesium metabolism, other chest pain, acute systolic heart failure, anxiety disorder, and other primary cardiomyopathy.
A logistic classification of above allowed for a more direct way to incorporate a weighting scheme to score each of the six factors and demographic information, to classify patients as having either TTS or ALWMI.
Results: The rate of TTS stabilized at around 2% of all MI’s,female and white race were higher and event rates for heart failure and cardiovascular deaths were lower. The results for the logistic classification using the 6 prespecified features, race, sex, and age were: for TTS; sensitivity 0.84, specificity 0.71, precision rate 0.36, and correct classification rate 0.73. For MI; negative predictive value was 0.96.
Conclusions: The algorithm of above noted comorbidities and conditions at presentation is useful in differential diagnosis, points to potential mechanisms and may explain recurrences of TTS. It is derived from a non-selective database with no apparent bias and utilizes a bottom up approach.
Mitral valve prolapse syndrome/ Genes/ Pathways