NT-pro-BNP for diagnostic and prognostic evaluation in patients hospitalized for syncope
Abstract
Background Single clinical parameters are inaccurate for diagnostic and prognostic estimation in patients with syncope. The cardiac marker NT-pro-BNP has not thoroughly been evaluated for this application.Methods NT-pro-BNP was assessed in 161 consecutive patients (median age 69 years, 58% male) hospitalized for syncope in a cardiological university department and association (odds ratio: OR, 95% confidence interval: CI) with diagnosis of cardiac cause and 6-months outcome was analyzed.Results NT-pro-BNP levels were significantly higher in patients with cardiac (n=78) compared to non-cardiac syncope (n=83). At a cutoff of 156 pg/ml, NT-pro-BNP showed a sensitivity of 89.7%, a specificity of 51.8% and a negative predictive value of 84.3% for the diagnosis of cardiac syncope. Increasing NT-pro-BNP was a significant predictor of cardiac syncope (OR 3.7, 95% CI 2.3-5.8 per standard deviation of Log NT-pro-BNP, p<0.001) and addition of NT-pro-BNP significantly improved a predictive model including heart rate, history of structural heart disease and abnormal ECG. Adding left-ventricular ejection fraction to the model did not change results. Sixty-three patients had an adverse event during hospitalization or 6-months follow-up. NT-pro-BNP>156 pg/ml significantly predicted an adverse outcome (OR 2.7, 95% CI 1.04-6.9, p=0.04) after multivariate adjustment.Conclusions In patients hospitalized for syncope, NT-pro-BNP was a strong and independent diagnostic and prognostic marker and addition to conventional criteria of history and examination improved the discriminatory performance. Randomized trials must clarify the benefit and position of NT-pro-BNP in the management algorithm of patients with syncope.
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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 [223]
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2018 ESC Guidelines for the diagnosis and management of syncope
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Prognostic value of cardiac biomarkers in the risk stratification of syncope: a systematic review
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- Authors
- Pfister, R., Hagemeister, J., Esser, S., Hellmich, M., Erdmann, E., & Schneider, C. A.
- Affiliations
- University of Cologne (DE)
- Corresponding author
- Pfister, Roman
- Venue
- International Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2012-03
- Volume
- 155
- Issue
- 2
- Pages
- 268-272
- ISSN
- 0167-5273 (ISSN-L)
- OpenAlex
- W2101806525
- Cited by
- 35
- References
- 22
- Citations by year
- 2026: 1 · 2024: 1 · 2023: 1 · 2022: 6 · 2021: 1 · 2020: 1 · 2019: 2 · 2018: 2 · 2017: 2 · 2015: 4 · 2014: 6 · 2013: 3 · 2012: 3
- FWCI
- 2.70
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- International Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Takotsubo Cardiomyopathy and Associated Phenomena
- Keywords
- NT-proBNP, syncope, cardiac syncope, cardiac biomarkers, diagnostic accuracy, prognostic factors, adverse outcome prediction, left ventricular ejection fraction, structural heart disease, heart rate
- MeSH terms
- Aged, Algorithms, Arrhythmias, Cardiac, Female, Heart Diseases, Hospitalization, Humans, Male, Middle Aged, Peptide Fragments, Predictive Value of Tests, Prognosis, Sensitivity and Specificity, Syncope, Biomarkers, Natriuretic Peptide, Brain
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