B-Type Natriuretic Peptides and Cardiac Troponins for Diagnosis and Risk-Stratification of Syncope.

NT-proBNP brain natriuretic peptide emergency service, hospital syncope troponin

Journal

Circulation
ISSN: 1524-4539
Titre abrégé: Circulation
Pays: United States
ID NLM: 0147763

Informations de publication

Date de publication:
21 May 2019
Historique:
medline: 26 2 2019
pubmed: 26 2 2019
entrez: 26 2 2019
Statut: ppublish

Résumé

The utility of BNP (B-type natriuretic peptide), NT-proBNP (N-terminal proBNP), and hs-cTn (high-sensitivity cardiac troponin) concentrations for diagnosis and risk-stratification of syncope is incompletely understood. We evaluated the diagnostic and prognostic accuracy of BNP, NT-proBNP, hs-cTnT, and hs-cTnI concentrations, alone and against those of clinical assessments, in patients >45-years old presenting with syncope to the emergency department in a prospective diagnostic multicenter study. BNP, NT-proBNP, hs-cTnT and hs-cTnI concentrations were measured in a blinded fashion. Cardiac syncope, as adjudicated by 2 physicians based on all information available including cardiac work-up and 1-year follow-up, was the diagnostic end point. EGSYS (Evaluation of Guidelines in Syncope Study), a syncope-specific diagnostic score, served as the diagnostic comparator. Death and major adverse cardiac events at 30 and 720 days were the prognostic end points. Major adverse cardiac events were defined as death, cardiopulmonary resuscitation, life-threatening arrhythmia, implantation of pacemaker/implantable cardioverter defibrillator, acute myocardial infarction, pulmonary embolism, stroke/transient ischemic attack, intracranial bleeding, or valvular surgery. ROSE (Risk Stratification of Syncope in the Emergency Department), OESIL (Osservatorio Epidemiologico della Sincope nel Lazio), SFSR (San Fransisco Syncope Rule), and CSRS (Canadian Syncope Risk Score) served as the prognostic comparators. Among 1538 patients eligible for diagnostic assessment, cardiac syncope was the adjudicated diagnosis in 234 patients (15.2%). BNP, NT-proBNP, hs-cTnT, and hs-cTnI were significantly higher in cardiac syncope versus other causes ( BNP, NT-proBNP, hs-cTnT, and hs-cTnI concentrations provide useful diagnostic and prognostic information in emergency department patients with syncope. URL: https://www. gov. Unique identifier: NCT01548352.

Sections du résumé

BACKGROUND BACKGROUND
The utility of BNP (B-type natriuretic peptide), NT-proBNP (N-terminal proBNP), and hs-cTn (high-sensitivity cardiac troponin) concentrations for diagnosis and risk-stratification of syncope is incompletely understood.
METHODS METHODS
We evaluated the diagnostic and prognostic accuracy of BNP, NT-proBNP, hs-cTnT, and hs-cTnI concentrations, alone and against those of clinical assessments, in patients >45-years old presenting with syncope to the emergency department in a prospective diagnostic multicenter study. BNP, NT-proBNP, hs-cTnT and hs-cTnI concentrations were measured in a blinded fashion. Cardiac syncope, as adjudicated by 2 physicians based on all information available including cardiac work-up and 1-year follow-up, was the diagnostic end point. EGSYS (Evaluation of Guidelines in Syncope Study), a syncope-specific diagnostic score, served as the diagnostic comparator. Death and major adverse cardiac events at 30 and 720 days were the prognostic end points. Major adverse cardiac events were defined as death, cardiopulmonary resuscitation, life-threatening arrhythmia, implantation of pacemaker/implantable cardioverter defibrillator, acute myocardial infarction, pulmonary embolism, stroke/transient ischemic attack, intracranial bleeding, or valvular surgery. ROSE (Risk Stratification of Syncope in the Emergency Department), OESIL (Osservatorio Epidemiologico della Sincope nel Lazio), SFSR (San Fransisco Syncope Rule), and CSRS (Canadian Syncope Risk Score) served as the prognostic comparators.
RESULTS RESULTS
Among 1538 patients eligible for diagnostic assessment, cardiac syncope was the adjudicated diagnosis in 234 patients (15.2%). BNP, NT-proBNP, hs-cTnT, and hs-cTnI were significantly higher in cardiac syncope versus other causes (
CONCLUSIONS CONCLUSIONS
BNP, NT-proBNP, hs-cTnT, and hs-cTnI concentrations provide useful diagnostic and prognostic information in emergency department patients with syncope.
CLINICAL TRIAL REGISTRATION BACKGROUND
URL: https://www.
CLINICALTRIALS RESULTS
gov. Unique identifier: NCT01548352.

Identifiants

DOI: 10.1161/CIRCULATIONAHA.118.038358 PMID: 30798615
pubmed: 30798615
doi: 10.1161/CIRCULATIONAHA.118.038358
doi:

Banques de données

ClinicalTrials.gov
['NCT01548352']

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

2403-2418

Commentaires et corrections

Type : CommentIn
Type : CommentIn
Type : CommentIn

Auteurs

Jeanne du Fay de Lavallaz (J)

Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (J.d.F.d.L., P.B., T.N., T.Z., J.W., R.T., C.P., D.W., J.B., L.K., I.S., J.L., E.M., M.K., T.R.).
GREAT Network, Roma, Italy (J.d.F.d.L., P.B., T.N., T.Z., O.M., E.S., L.C., M.F., F.J.M.-S., S.D.S., W.F.P., B.M., J.W., R.T., C.P., D.W., J.B., L.K., I.S.).

Patrick Badertscher (P)

Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (J.d.F.d.L., P.B., T.N., T.Z., J.W., R.T., C.P., D.W., J.B., L.K., I.S., J.L., E.M., M.K., T.R.).
GREAT Network, Roma, Italy (J.d.F.d.L., P.B., T.N., T.Z., O.M., E.S., L.C., M.F., F.J.M.-S., S.D.S., W.F.P., B.M., J.W., R.T., C.P., D.W., J.B., L.K., I.S.).
Division of Cardiology, University of Illinois at Chicago, IL (P.B.).

Thomas Nestelberger (T)

Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (J.d.F.d.L., P.B., T.N., T.Z., J.W., R.T., C.P., D.W., J.B., L.K., I.S., J.L., E.M., M.K., T.R.).
GREAT Network, Roma, Italy (J.d.F.d.L., P.B., T.N., T.Z., O.M., E.S., L.C., M.F., F.J.M.-S., S.D.S., W.F.P., B.M., J.W., R.T., C.P., D.W., J.B., L.K., I.S.).

Tobias Zimmermann (T)

Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (J.d.F.d.L., P.B., T.N., T.Z., J.W., R.T., C.P., D.W., J.B., L.K., I.S., J.L., E.M., M.K., T.R.).
GREAT Network, Roma, Italy (J.d.F.d.L., P.B., T.N., T.Z., O.M., E.S., L.C., M.F., F.J.M.-S., S.D.S., W.F.P., B.M., J.W., R.T., C.P., D.W., J.B., L.K., I.S.).

Òscar Miró (Ò)

GREAT Network, Roma, Italy (J.d.F.d.L., P.B., T.N., T.Z., O.M., E.S., L.C., M.F., F.J.M.-S., S.D.S., W.F.P., B.M., J.W., R.T., C.P., D.W., J.B., L.K., I.S.).
Hospital Clinic, Barcelona, Catalonia, Spain (O.M., E.S.).

Emilio Salgado (E)

GREAT Network, Roma, Italy (J.d.F.d.L., P.B., T.N., T.Z., O.M., E.S., L.C., M.F., F.J.M.-S., S.D.S., W.F.P., B.M., J.W., R.T., C.P., D.W., J.B., L.K., I.S.).
Hospital Clinic, Barcelona, Catalonia, Spain (O.M., E.S.).

Michael Christ (M)

Department of Emergency Medicine, Kantonsspital Luzern, Switzerland (M.C.).

Nicolas Geigy (N)

Department of Emergency Medicine, Hospital of Liestal, Switzerland (N.G.).

Louise Cullen (L)

GREAT Network, Roma, Italy (J.d.F.d.L., P.B., T.N., T.Z., O.M., E.S., L.C., M.F., F.J.M.-S., S.D.S., W.F.P., B.M., J.W., R.T., C.P., D.W., J.B., L.K., I.S.).
Royal Brisbane & Women's Hospital, Herston, Australia (L.C.).

Martin Than (M)

Christchurch Hospital, Christchurch, New Zealand (M.T.).

F Javier Martin-Sanchez (F)

GREAT Network, Roma, Italy (J.d.F.d.L., P.B., T.N., T.Z., O.M., E.S., L.C., M.F., F.J.M.-S., S.D.S., W.F.P., B.M., J.W., R.T., C.P., D.W., J.B., L.K., I.S.).
Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain (F.J.M.S.).

Salvatore Di Somma (S)

GREAT Network, Roma, Italy (J.d.F.d.L., P.B., T.N., T.Z., O.M., E.S., L.C., M.F., F.J.M.-S., S.D.S., W.F.P., B.M., J.W., R.T., C.P., D.W., J.B., L.K., I.S.).
Emergency Medicine, Department of Medical-Surgery Sciences and Translational Medicine, University Sapienza Rome, Sant'Andrea Hospital, Italy (S.D.S.).

W Frank Peacock (W)

GREAT Network, Roma, Italy (J.d.F.d.L., P.B., T.N., T.Z., O.M., E.S., L.C., M.F., F.J.M.-S., S.D.S., W.F.P., B.M., J.W., R.T., C.P., D.W., J.B., L.K., I.S.).
Baylor College of Medicine, Department of Emergency Medicine, Houston, TX (W.F.P.).

Beata Morawiec (B)

GREAT Network, Roma, Italy (J.d.F.d.L., P.B., T.N., T.Z., O.M., E.S., L.C., M.F., F.J.M.-S., S.D.S., W.F.P., B.M., J.W., R.T., C.P., D.W., J.B., L.K., I.S.).
2nd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland (B.M.).

Joan Walter (J)

Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (J.d.F.d.L., P.B., T.N., T.Z., J.W., R.T., C.P., D.W., J.B., L.K., I.S., J.L., E.M., M.K., T.R.).
GREAT Network, Roma, Italy (J.d.F.d.L., P.B., T.N., T.Z., O.M., E.S., L.C., M.F., F.J.M.-S., S.D.S., W.F.P., B.M., J.W., R.T., C.P., D.W., J.B., L.K., I.S.).

Raphael Twerenbold (R)

Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (J.d.F.d.L., P.B., T.N., T.Z., J.W., R.T., C.P., D.W., J.B., L.K., I.S., J.L., E.M., M.K., T.R.).
GREAT Network, Roma, Italy (J.d.F.d.L., P.B., T.N., T.Z., O.M., E.S., L.C., M.F., F.J.M.-S., S.D.S., W.F.P., B.M., J.W., R.T., C.P., D.W., J.B., L.K., I.S.).
Department of General and Interventional Cardiology, University Heart Center Hamburg, University Hospital Hamburg-Eppendorf, Hamburg, Germany (R.T.).

Christian Puelacher (C)

Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (J.d.F.d.L., P.B., T.N., T.Z., J.W., R.T., C.P., D.W., J.B., L.K., I.S., J.L., E.M., M.K., T.R.).
GREAT Network, Roma, Italy (J.d.F.d.L., P.B., T.N., T.Z., O.M., E.S., L.C., M.F., F.J.M.-S., S.D.S., W.F.P., B.M., J.W., R.T., C.P., D.W., J.B., L.K., I.S.).

Desiree Wussler (D)

Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (J.d.F.d.L., P.B., T.N., T.Z., J.W., R.T., C.P., D.W., J.B., L.K., I.S., J.L., E.M., M.K., T.R.).
GREAT Network, Roma, Italy (J.d.F.d.L., P.B., T.N., T.Z., O.M., E.S., L.C., M.F., F.J.M.-S., S.D.S., W.F.P., B.M., J.W., R.T., C.P., D.W., J.B., L.K., I.S.).

Jasper Boeddinghaus (J)

Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (J.d.F.d.L., P.B., T.N., T.Z., J.W., R.T., C.P., D.W., J.B., L.K., I.S., J.L., E.M., M.K., T.R.).
GREAT Network, Roma, Italy (J.d.F.d.L., P.B., T.N., T.Z., O.M., E.S., L.C., M.F., F.J.M.-S., S.D.S., W.F.P., B.M., J.W., R.T., C.P., D.W., J.B., L.K., I.S.).

Luca Koechlin (L)

Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (J.d.F.d.L., P.B., T.N., T.Z., J.W., R.T., C.P., D.W., J.B., L.K., I.S., J.L., E.M., M.K., T.R.).
GREAT Network, Roma, Italy (J.d.F.d.L., P.B., T.N., T.Z., O.M., E.S., L.C., M.F., F.J.M.-S., S.D.S., W.F.P., B.M., J.W., R.T., C.P., D.W., J.B., L.K., I.S.).
Department of Heart Surgery, University Hospital Basel, Switzerland (L.K.).

Ivo Strebel (I)

Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (J.d.F.d.L., P.B., T.N., T.Z., J.W., R.T., C.P., D.W., J.B., L.K., I.S., J.L., E.M., M.K., T.R.).
GREAT Network, Roma, Italy (J.d.F.d.L., P.B., T.N., T.Z., O.M., E.S., L.C., M.F., F.J.M.-S., S.D.S., W.F.P., B.M., J.W., R.T., C.P., D.W., J.B., L.K., I.S.).

Dagmar I Keller (DI)

Emergency Department, University Hospital Zurich, Switzerland (D.I.K.).

Jens Lohrmann (J)

Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (J.d.F.d.L., P.B., T.N., T.Z., J.W., R.T., C.P., D.W., J.B., L.K., I.S., J.L., E.M., M.K., T.R.).

Eleni Michou (E)

Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (J.d.F.d.L., P.B., T.N., T.Z., J.W., R.T., C.P., D.W., J.B., L.K., I.S., J.L., E.M., M.K., T.R.).

Michael Kühne (M)

Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (J.d.F.d.L., P.B., T.N., T.Z., J.W., R.T., C.P., D.W., J.B., L.K., I.S., J.L., E.M., M.K., T.R.).

Tobias Reichlin (T)

Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (J.d.F.d.L., P.B., T.N., T.Z., J.W., R.T., C.P., D.W., J.B., L.K., I.S., J.L., E.M., M.K., T.R.).
Department of Cardiology, Inselspital, Bern, University Hospital, University of Bern, Switzerland (T.R.).

Christian Mueller (C)

Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (J.d.F.d.L., P.B., T.N., T.Z., J.W., R.T., C.P., D.W., J.B., L.K., I.S., J.L., E.M., M.K., T.R.).

Classifications MeSH