TAKO TSUBO CARDIOMYOPATHY OR MYOCARDITIS?

dysfunction, often triggered by a physical or emotional stressor, which predominantly affects postmenopausal women. At presentation it mimics an AMI in the absence of atherosclerotic obstruction of epicardial coronary arteries and acute myocarditis. The aim of our study was to identify a simple non-invasive marker to differentiate CTS from acute myocarditis Materials and Methods: From January 2011 to June 2016, 36 patients with CTS (CTS group) were admitted to our CCU and 34 patients with acute myocarditis, constitutes the control group (Myo). We analyzed the clinical features, risk factors, the ECG and the echocardiographic tests. We then calculated: peak troponin/WMSI index as the ratio between the peak troponin and the WMSI at first echocardiography . Results: Peak troponin was significantly lower in CTS group compared to Myo (9.5 vs 45 ng/ml, p<0.0001).We found a significant difference with regard to the EF and WMSI from CTS and Myo group on admission echocardiography (EF 48±10.2 vs 58±8 p=0.001 and WMSI 1.9±0,3 vs 1.3±0.3, p<0.001). CTS patients showed a significant early functional recovery (EF from 48±10.2 to 61 ±6.7,p<0.001, WMSI from 1.8±0,3 to 1,2±0.2,p<0.0001 ) more than Myo (EF from 58±7,8 to 61±6.7, p=ns, and WMSI from 1.3±0.3 to 1.1±0.2,p=0.05). Patients with CTS had a peak troponin/ WMSI significantly lower than Myo (5.9 vs 36, p<0.0001). From the ROC curves a peak troponin/ WMSI index ≥0.91 was found to have a sensitivity of 76% and a specificity of 77% in identifying a CTS compared to acute myocarditis with a diagnostic accuracy of 76% and a VVP of 76 %, NPV 77%. Conclusions: Our study confirms that there is a considerable discrepancy between regional and global dysfunction and troponin peak in CTS patients and acute myocarditis . These factors confirm myocardial stunning in CTS group and justify the rapid functional recovery of our patients in comparison to myocarditis patients. We have identified non-invasive parameters easily achievable in acute phase and highly accurate in differentiating non-invasively the CTS patient from the acute myocarditis patients.