InterTAK Diagnostic Score and Prognostic Score for Takotsubo cardiomyopathy

InterTAK Diagnostic Score and Prognostic Score for Takotsubo cardiomyopathy

InterTAK Diagnostic Score was developed from the results of International Takotsubo Registry [1] by the InterTAK International Registry Group. The score was developed for differentiating Takotsubo cardiomyopathy from acute coronary syndrome in the acute stage. InterTAK Diagnostic Score estimates the probability for Takotsubo cardiomyopathy and was found to have high sensitivity and specificity for differentiating it from acute coronary syndrome.

Points were allocated as follows:

Female gender: 25 points
Emotional trigger: 24 points
Physical trigger: 13 points
Absence of ST-segment depression: 12 points
Psychiatric disorders: 11 points
Neurologic disorders: 9 points
QTc prolongation: 6 points

If 50 or more points were present, the specificity of Takotsubo cardiomyopathy was 95%. If score was 31 or less, the specificity of acute coronary syndrome was also 95%.

InterTAK Diagnostic Score was evaluated in a study of 40 consecutive patients with acute coronary syndrome and 20 patients with Takotsubo cardiomyopathy at a single centre in Poland [2]. They found highest sum of sensitivity and specificity while using a cut-off value of 45 points. With a score≥ 50, 85% were correctly diagnosed as Takotsubo cardiomyopathy. When the score was ≤ 31, 92% were correctly diagnosed as acute coronary syndrome.

InterTAK Prognostic Score

InterTAK Prognostic Score aims at predicting short term and long term mortality in takotsubo syndrome [3]. Data from the InterTAK Registry which comprised of Takotsubo syndrome (TTS) patients from 26 centers worldwide was used for derivation of the score. Regression coefficients of risk factors were obtained by Cox regression analysis. 1160 patients were included in the study.

InterTAK Prognostic Score gave points as follows: TTS secondary to neurologic disorders 15 points, TTS secondary to physical activities, medical conditions or procedure 9 points, age above 70 years 8 points, systolic blood pressure less than 119 mm Hg on admission 7 points, diabetes mellitus 6 points, left ventricular ejection fraction 45% or less on admission 6 points, male sex 6 points, heart rate above 94/min on admission 4 points, TTS without an identifiable triggering factor 3 points [3].

The points were added together and those with 15 or less points were considered as low risk. Intermediate risk was assigned to those with 16-22 points, high risk to those with 23-28 points and very high risk for those with 29 points or more. Five year survival in the low risk group was 93.5% and that in very high risk group was 45.1%. Survival in other groups were in between [3].

References

1. Ghadri JR, Cammann VL, Jurisic S, Seifert B, Napp LC, Diekmann J, Bataiosu DR, D’Ascenzo F, Ding KJ, Sarcon A, Kazemian E, Birri T, Ruschitzka F, Lüscher TF, Templin C; InterTAK co-investigators. A novel clinical score (InterTAK Diagnostic Score) to differentiate takotsubo syndrome from acute coronary syndrome: results from the International Takotsubo Registry. Eur J Heart Fail. 2017 Aug;19(8):1036-1042.
2. Samul-Jastrzębska J, Roik M, Wretowski D, Łabyk A, Ślubowska A, Bizoń A, Paczyńska M, Kurnicka K, Pruszczyk P, Ciurzyński M. Evaluation of the InterTAK Diagnostic Score in differentiating Takotsubo syndrome from acute coronary syndrome. A single center experience. Cardiol J. 2019 Sep 6. doi: 10.5603/CJ.a2019.0086. Epub ahead of print. PMID: 31489610.
3. Wischnewsky MB, Candreva A, Bacchi B, Cammann VL, Kato K, Szawan KA, Gili S, D’Ascenzo F, Dichtl W, Citro R, Bossone E, Neuhaus M, Franke J, Sorici-Barb I, Jaguszewski M, Noutsias M, Knorr M, Heiner S, Burgdorf C, Kherad B, Tschöpe C, Sarcon A, Shinbane J, Rajan L, Michels G, Pfister R, Cuneo A, Jacobshagen C, Karakas M, Koenig W, Pott A, Meyer P, Arroja JD, Banning A, Cuculi F, Kobza R, Fischer TA, Vasankari T, Airaksinen KEJ, Napp LC, Budnik M, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Chan C, Bridgman P, Beug D, Delmas C, Lairez O, El-Battrawy I, Akin I, Gilyarova E, Shilova A, Gilyarov M, Kozel M, Tousek P, Winchester DE, Galuszka J, Ukena C, Poglajen G, Carrilho-Ferreira P, Hauck C, Paolini C, Bilato C, Prasad A, Rihal CS, Liu K, Schulze PC, Bianco M, Jörg L, Rickli H, Nguyen TH, Kobayashi Y, Böhm M, Maier LS, Pinto FJ, Widimský P, Borggrefe M, Felix SB, Opolski G, Braun-Dullaeus RC, Rottbauer W, Hasenfuß G, Pieske BM, Schunkert H, Thiele H, Bauersachs J, Katus HA, Horowitz J, Di Mario C, Münzel T, Crea F, Bax JJ, Lüscher TF, Ruschitzka F, Ghadri JR, Templin C. Prediction of short- and long-term mortality in takotsubo syndrome: the InterTAK Prognostic Score. Eur J Heart Fail. 2019 Nov;21(11):1469-1472. doi: 10.1002/ejhf.1561. Epub 2019 Aug 27. PMID: 31452320.