099: Analysis of BNP and troponin I to differentiate apical ballooning syndrome from acute coronary syndrome

Objectives We sought to analyze B-type natriuretic peptide (BNP)/troponin I (TnI) ratio and TnI kinetics to differentiate apical ballooning syndrome (ABS) from acute coronary syndrome (ACS). Methods In 62 ABS, TnI and BNP measurements were collected prospectively and compared to 90 patients with anterior ST-segment elevation myocardial infarctions (STEMI) (n=47) and anterior non-STEMI (n=43). Results In case of persistent ST-segment elevation, BNP/TnI ratio above 165 can identify ABS with accuracy (sensitivity: 95%, specificity: 98%). In the absence of persistent ST-segment elevation, a ratio above 515 can identify ABS (sensitivity: 57%, specificity: 86%). Decreasing TnI profile was found more in ABS than in ACS. TnI peak occurred earlier in ABS than in ACS. A normal TnI on patient admission may exclude ABS. Conclusions Analysis of BNP and TnI provides a simple, non-invasive method to differentiate ABS from ACS.