Prognostic value of cardiac biomarkers in the risk stratification of syncope: a systematic review
Abstract
The role of cardiac biomarkers in risk stratification of syncope is unclear. We undertook a systematic review to assess their predictive value for short-term major adverse cardiovascular events (MACE). We conducted a systematic review using MEDLINE, EMBASE, DARE and Cochrane databases from inception to July 2014. We included studies involving adult syncope patients that evaluated cardiac biomarker levels for risk stratification during acute management and excluded case reports, reviews and studies involving children. Primary outcome (MACE) included death, cardiopulmonary resuscitation, myocardial infarction (MI), structural heart disease, pulmonary embolism, significant hemorrhage or cardiac procedural interventions. Secondary outcome analysis assessed for prediction of MI, cardiac syncope and death. Two reviewers extracted patient-level data based on the cut-off reported. Pooled sensitivities and specificities were calculated using patient-level data. A total of 1862 articles were identified, and 11 studies with 4246 patients were included. Studies evaluated 3 biomarkers: contemporary troponin (2693 patients), natriuretic peptides (1353 patients) and high-sensitive troponin (819 patients). The pooled sensitivities and specificities for MACE were: contemporary troponin 0.29 (95 % CI 0.24, 0.34) and 0.88 (95 % CI 0.86, 0.89); natriuretic peptides 0.77 (95 % CI 0.69, 0.85) and 0.73 (95 % CI 0.70, 0.76); high-sensitive troponin 0.74 (95 % CI 0.65, 0.83) and 0.65 (95 % CI 0.62, 0.69), respectively. Natriuretic peptides and high-sensitive troponin showed good diagnostic characteristics for both primary and secondary outcomes. Natriuretic peptides and high-sensitive troponin might be useful in risk stratification.
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Established cardiac biomarkers such as troponin and B-type natriuretic peptide have been used to distinguish cardiac from non-cardiac syncope and identify structural heart disease.
“Established cardiac biomarkers such as troponin and B-type natriuretic peptide have been used to distinguish cardiac from non-cardiac syncope and identify structural heart disease. 223-225”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [225]
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- Authors
- Thiruganasambandamoorthy, V., Ramaekers, R., Rahman, M. O., Stiell, I. G., Sikora, L., Kelly, S.-L., Christ, M., Claret, P.-G., & Reed, M. J.
- Affiliations
- University of Ottawa (CA)
- Edinburgh Royal Infirmary (GB)
- Nuremberg Hospital (DE)
- Corresponding author
- Thiruganasambandamoorthy, Venkatesh
- ORCID
- Venue
- Internal and Emergency Medicine
- Published
- 2015-10-23
- Volume
- 10
- Issue
- 8
- Pages
- 1003-1014
- ISSN
- 1828-0447 (ISSN-L)
- 1970-9366
- OpenAlex
- W2172795178
- Cited by
- 36
- References
- 30
- Citations by year
- 2025: 1 · 2024: 2 · 2023: 4 · 2022: 2 · 2021: 2 · 2020: 7 · 2019: 5 · 2018: 4 · 2017: 8 · 2016: 1
- FWCI
- 0.83
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Internal and Emergency Medicine (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion)
- Funders
- Department of Emergency Medicine, University of Ottawa
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Keywords
- syncope, cardiac biomarkers, risk stratification, major adverse cardiovascular events, high-sensitivity troponin, natriuretic peptides, myocardial infarction, cardiac syncope, prognostic value, diagnostic accuracy
- MeSH terms
- Humans, Myocardial Infarction, Prognosis, Syncope, Troponin, Biomarkers, Cardiopulmonary Resuscitation, Risk Assessment, Natriuretic Peptide, Brain
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