Brain natriuretic peptide in apical ballooning syndrome (Takotsubo/stress cardiomyopathy): Comparison with acute myocardial infarction

OBJECTIVES: Apical ballooning syndrome (ABS) is a transient cause of ventricular dysfunction. The aim of this study was to determine the clinical and hemodynamic correlates of brain natriuretic peptide (BNP) levels in ABS and compare the biomarker profiles in ABS with acute myocardial infarction controls. METHODS: Fifty-seven prospectively diagnosed patients with ABS whose BNP and troponin T level measurements were available were included. Fifty patients with ST-elevation myocardial infarction (STEMI) and 25 individuals with non-ST-elevation myocardial infarction (NSTEMI) were included as matched controls. RESULTS: In the ABS cohort, the BNP levels were higher in patients older than 65 years compared with younger individuals: 767 (269, 951) versus 340 (131, 904.5), P=0.019. There were no significant correlations between BNP levels and hemodynamic parameters such as left ventricular ejection fraction and end diastolic pressure. There were no correlations between BNP and peak troponin T (r=0.03, P=0.8). BNP levels were significantly higher in ABS patients when compared with the STEMI and NSTEMI controls. The BNP to peak troponin T ratio was significantly higher in ABS compared with the STEMI controls 1089.4 (446.7, 3334.8) versus 97.4 (17.9, 264.7), P=0.04. CONCLUSION: BNP elevation is almost universal in ABS. Cardiac hemodynamic indices do not correlate with BNP levels. The magnitude of BNP elevation is higher in ABS compared with STEMI and NSTEMI.