A blood test told broken-heart syndrome from a heart attack nine times out of ten

Doctors have long faced an uncomfortable diagnostic problem: a condition triggered by sudden emotional or physical stress can produce chest pain, abnormal heart readings, and elevated cardiac enzymes that look almost identical to a heart attack. Telling the two apart has typically required threading a catheter into a patient’s heart. Researchers working across Switzerland and Germany say they have built a blood-based scoring system that can make that distinction with striking accuracy before that invasive step is ever needed.

The condition in question is Takotsubo syndrome, more commonly known as broken-heart syndrome, which tends to strike postmenopausal women after an intense stressful event. It accounts for roughly 2 percent of patients initially suspected of having a heart attack, and for as many as one in ten women evaluated for acute coronary syndrome specifically. Unlike a true heart attack, Takotsubo syndrome does not involve a blocked coronary artery, but the two conditions present with such similar symptoms that most patients still end up undergoing cardiac catheterization simply to find out which one they have.

Building the BioTAK Score

An international research team working with scientists at the universities of Zurich and Greifswald developed a diagnostic tool called the BioTAK score, which combines a patient’s biological sex with several blood biomarkers tied to different processes inside the cardiovascular system. Rather than guessing which biomarkers might matter, the researchers used artificial intelligence to identify which combination carried the most diagnostic value, then built that combination into a practical clinical scoring tool intended for use before catheterization takes place.

How Accurately the Score Performed

When tested against an independent validation group of nearly 1,800 additional patients, the score correctly classified almost 90 percent of participants using predefined thresholds, identifying Takotsubo syndrome before any of them underwent cardiac catheterization. Florian A. Wenzl, a co-first author of the study affiliated with the University of Zurich’s Center for Molecular Cardiology and the University of Oxford, said the results show that a simple combination of blood biomarkers and biological sex can identify these patients with remarkable accuracy even before invasive testing begins.

What the Biomarkers Reveal About the Disease Itself

Beyond its use as a diagnostic shortcut, the score also points to biological mechanisms that separate broken-heart syndrome from an ordinary heart attack. Two of the biomarkers included in the BioTAK score are tied to what researchers describe as a brain-heart axis, a signaling pathway connecting stress-related neuropeptides, vascular tone, and autonomic nervous system activity to the heart itself. One protein in the score helps activate neuropeptides involved in stress and anxiety responses, while the other is linked to the stability of arterial plaque, a marker more typically associated with classic coronary disease. Thomas Lüscher of the National Heart and Lung Institute at Imperial College London, a co-senior author on the study published in the European Heart Journal, said the score translates complex disease mechanisms into a tool that clinicians can actually use at the bedside.

From Research Registries to the Emergency Room

The data behind the score came from prospective patient cohorts in Switzerland, the SPUM-ACS Registry, and the International Takotsubo Registry, an infrastructure established in 2010 that has become one of the largest research networks focused on the condition. In total, researchers analyzed records from more than 3,600 patients who had either acute coronary syndrome or Takotsubo syndrome. Christian Templin, director of the Department of Internal Medicine B at the University Medical Center Greifswald and founder of the Takotsubo registry, said the score is not meant to replace cardiac catheterization when it is medically necessary, but could help guide which patients need it most and reduce unnecessary invasive procedures in others. The research team’s next step is examining whether folding the BioTAK score into routine emergency care measurably changes how quickly and accurately broken-heart syndrome gets diagnosed.

Why Emergency Rooms Struggle With This Diagnosis Today

The underlying clinical problem is not rare, even if the condition itself gets far less public attention than a standard heart attack. Because Takotsubo syndrome typically follows an acute stressor, ranging from the death of a loved one to a serious accident, its onset often looks clinically indistinguishable from a coronary event happening in real time, and current emergency protocols are built around ruling out the more common and more immediately dangerous possibility first. That default toward catheterization is medically reasonable given the stakes of missing a genuine blockage, but it also means many patients whose hearts are not actually blocked still undergo an invasive procedure, along with the recovery time, cost, and small procedural risk that comes with it.

A blood-based score that performs with close to 90 percent accuracy does not eliminate that default, since the researchers themselves describe it as a complement to catheterization rather than a replacement for it. What it offers instead is a way to triage more confidently in the minutes after a patient arrives with chest pain and an abnormal reading, potentially identifying a subset of patients for whom the invasive step can be delayed or reconsidered while still catching the cases where catheterization remains necessary. Because the score draws on biomarkers tied to the brain-heart axis rather than markers already used to detect blocked arteries, it is measuring something genuinely different from the tests already built into standard coronary workups, which is part of why the research team frames it as additive rather than duplicative.

This article was created with the assistance of AI and reviewed by an editor.

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