A new diagnostic tool called the BioTAK score can identify Takotsubo syndrome before cardiac catheterisation with an accuracy rate approaching 90%, according to a study published in the European Heart Journal. The BioTAK score Takotsubo diagnosis method combines biological sex with blood biomarkers, and was validated in a group of nearly 1,800 patients drawn from major international registries.
Takotsubo syndrome, sometimes called broken heart syndrome, is a sudden cardiac condition most often affecting postmenopausal women and commonly triggered by intense emotional or physical stress. It accounts for about 2% of patients initially presenting as a suspected heart attack, and up to one in ten women with acute coronary syndrome. The diagnostic problem is an old one: patients can present with chest pain, abnormal electrocardiogram results, and elevated cardiac enzymes, a clinical picture that closely mirrors a heart attack. The critical distinction is that Takotsubo syndrome does not involve blocked coronary arteries. Without that distinction being clear from the outset, many patients end up undergoing invasive cardiac catheterisation simply to rule one condition out.
What the BioTAK score Takotsubo diagnosis tool actually measures
The score comprises five variables. According to the study in the European Heart Journal, these are NT-proBNP, PAM, sLOX-1, LDL-C, and biological sex. Researchers at the University of Zurich and the University of Greifswald, working with an international team, used artificial intelligence to determine which combination of biomarkers carried the most diagnostic weight, then built those markers into a clinical decision tool.
The performance figures, reported by StudyFinds, are worth examining directly. In the derivation group used to build the score, the BioTAK achieved an area under the curve of 0.97, on a scale where 1.0 represents perfect separation between conditions and 0.5 represents pure guesswork. In the independent validation group of nearly 1,800 patients, it held at 0.93. Using predefined thresholds, the system correctly classified nearly 90% of participants before cardiac catheterisation took place. Those are strong numbers, though the researchers are appropriately cautious about what they mean in routine clinical practice.
‘Our study shows that a simple combination of blood biomarkers and biological sex can identify these patients with remarkable accuracy even before cardiac catheterisation,’ says Florian A. Wenzl, co-first author of the study at the Center for Molecular Cardiology at the University of Zurich and the Radcliffe Department of Medicine at the University of Oxford. Co-first author Victor Schweiger of University Hospital Zurich adds that the biomarkers also ‘provide insights into the biological processes that distinguish Takotsubo syndrome from a classic heart attack.’
What the biomarkers reveal about the underlying biology
Two newly identified proteins in the BioTAK score point to what researchers describe as the brain-heart axis, suggesting that Takotsubo syndrome develops through mechanisms that are separate from atherosclerosis. One protein helps activate neuropeptides involved in stress responses, anxiety, vascular tone, and autonomic nervous system activity. The other is associated with the stability of atherosclerotic plaques. Together, the two markers describe a biological pattern the researchers say is fundamentally different from the one seen in a classic heart attack.
‘By capturing signalling pathways related to stress responses, cardiac dysfunction and plaque stability, the BioTAK score translates complex disease mechanisms into a practical diagnostic tool,’ says co-last author Thomas Lüscher of the National Heart and Lung Institute at Imperial College London.
Co-last author Christian Templin, director of the Department of Internal Medicine B at the University Medical Center Greifswald and founder of the InterTAK Registry, is careful about the scope of the tool’s application. ‘The BioTAK score is not a substitute for cardiac catheterisation when it is medically necessary,’ he says. ‘However, it could help guide diagnostic procedures more effectively and avoid unnecessary invasive tests in selected patients.’
The study drew on patient data from the SPUM-ACS Registry and the International Takotsubo (InterTAK) Registry, established in 2010 and described as one of the world’s largest research infrastructures focused on Takotsubo syndrome. In total, researchers analysed data from more than 3,600 patients with either acute coronary syndrome or Takotsubo syndrome. Further research, the team says, will examine whether adding the BioTAK score to routine clinical care can improve how Takotsubo syndrome is both diagnosed and treated.
