BioTAK Score Distinguishes Takotsubo Syndrome From Heart Attack in Validation Study

A new diagnostic scoring system may help distinguish Takotsubo syndrome from a heart attack before invasive cardiac catheterization, according to research published in the European Heart Journal. The BioTAK score combines biological sex with blood biomarkers and correctly classified nearly 90% of patients in an independent validation group of almost 1,800 people.

Takotsubo syndrome—sometimes called “broken heart syndrome”—can produce chest pain, abnormal electrocardiogram findings and elevated cardiac enzymes, making it difficult to separate from a heart attack during an initial emergency evaluation. The conditions differ in a key respect: Takotsubo syndrome does not involve blocked coronary arteries.

The condition most often affects postmenopausal women and can follow intense emotional or physical stress. The University of Zurich, which supplied the report, said Takotsubo syndrome accounts for about 2% of patients initially thought to be having a heart attack and as many as one in 10 women with acute coronary syndrome.

Researchers from an international team working with scientists at the universities of Zurich and Greifswald developed the score using data from prospective patient groups in Switzerland’s SPUM-ACS Registry and the International Takotsubo Registry. Overall, the study analyzed more than 3,600 patients with either acute coronary syndrome or Takotsubo syndrome.

Artificial intelligence was used to identify the combination of biomarkers that offered the most useful diagnostic information. The final score included markers associated with different cardiovascular processes, along with biological sex.

The biomarker pattern also provided clues about the biology of Takotsubo syndrome. Two newly identified markers pointed to possible involvement of the brain-heart axis and mechanisms distinct from atherosclerosis, according to the researchers. One protein helps activate neuropeptides involved in stress responses, anxiety, vascular tone and autonomic nervous system activity. The other is associated with atherosclerotic plaque stability.

These findings describe biological differences between the conditions, but they do not establish that the score can replace established emergency procedures. Christian Templin, a study co-last author and director at the University Medical Center Greifswald, said the BioTAK score is not a substitute for cardiac catheterization when that procedure is medically necessary. Instead, it could help guide diagnostic decisions and potentially reduce unnecessary invasive testing in selected patients.

The researchers reported that further work will assess whether adding the score to routine clinical care improves the diagnosis and treatment of Takotsubo syndrome. The study was published in 2026 under the title “Takotsubo syndrome diagnosis: the biomarker-based BioTAK score.”