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

被引:47
作者
de Lavallaz, Jeanne du Fay [2 ,3 ,4 ]
Badertscher, Patrick [2 ,3 ,4 ,5 ]
Nestelberger, Thomas [2 ,3 ,4 ]
Zimmermann, Tobias [2 ,3 ,4 ]
Miro, Oscar [4 ,6 ]
Salgado, Emilio [4 ,6 ]
Christ, Michael [7 ]
Geigy, Nicolas [8 ]
Cullen, Louise [4 ,9 ]
Than, Martin [10 ]
Martin-Sanchez, F. Javier [4 ,11 ]
Di Somma, Salvatore [4 ,12 ]
Peacock, W. Frank [4 ,13 ]
Morawiec, Beata [4 ,14 ]
Walter, Joan [2 ,3 ,4 ]
Twerenbold, Raphael [2 ,3 ,4 ,15 ]
Puelacher, Christian [2 ,3 ,4 ]
Wussler, Desiree [2 ,3 ,4 ]
Boeddinghaus, Jasper [2 ,3 ,4 ]
Koechlin, Luca [2 ,3 ,4 ,16 ]
Strebel, Ivo [2 ,3 ,4 ]
Keller, Dagmar, I [17 ]
Lohrmann, Jens [2 ,3 ]
Michou, Eleni [2 ,3 ]
Kuhne, Michael [2 ,3 ]
Reichlin, Tobias [2 ,3 ,18 ]
Mueller, Christian [1 ]
Gimenez, Maria Rubini [2 ,3 ,4 ]
Kozhuharov, Nikola [2 ,3 ,4 ]
Shrestha, Samyut [2 ,3 ,4 ]
Sazgary, Lorraine [2 ,3 ,4 ]
Freese, Michael [2 ,3 ,4 ]
Meissner, Kathrin [2 ,3 ,4 ]
Kulangara, Caroline [2 ,3 ,4 ]
Hartmann, Beate [2 ,3 ,4 ]
Coehlo, Carine [2 ,3 ,4 ]
Joray, Lydia [2 ,3 ,4 ]
Lopez-Ayala, Pedro [2 ,3 ,4 ]
Breidthardt, Tobias [2 ,3 ,4 ]
Bingisser, Roland [2 ,3 ,4 ]
Bustamante Mandrion, Jose [4 ,11 ]
Poepping, Imke [19 ]
Kawecki, Damian [4 ,14 ]
Muzyk, Piotr [4 ,14 ]
Nowalany-Kozielska, Ewa [4 ,14 ]
Greenslade, Jaimi [9 ]
Hawkins, Tracey [9 ]
Rentsch, Katharina [20 ]
von Eckardstein, Arnold [20 ]
Buser, Andreas [21 ]
机构
[1] Univ Hosp Basel, Dept Cardiol, Petersgraben 4, CH-4031 Basel, Switzerland
[2] Univ Basel, Univ Hosp Basel, CRIB, Basel, Switzerland
[3] Univ Basel, Univ Hosp Basel, Dept Cardiol, Basel, Switzerland
[4] Great Network, Rome, Italy
[5] Univ Illinois, Div Cardiol, Chicago, IL 60680 USA
[6] Hosp Clin Barcelona, Barcelona, Spain
[7] Kantonsspital Luzern, Dept Emergency Med, Luzern, Switzerland
[8] Hosp Liestal, Dept Emergency Med, Liestal, Switzerland
[9] Royal Brisbane & Womens Hosp, Herston, Qld, Australia
[10] Christchurch Hosp, Christchurch, New Zealand
[11] Hosp Clin San Carlos, Serv Urgencias, Madrid, Spain
[12] Univ Sapienza Rome, St Andrea Hosp, Dept Med Surg Sci & Translat Med, Emergency Med, Rome, Italy
[13] Baylor Coll Med, Dept Emergency Med, Houston, TX 77030 USA
[14] Med Univ Silesia, Sch Med, Dept Cardiol 2, Div Dent Zabrze, Katowice, Poland
[15] Univ Hosp Hamburg Eppendorf, Univ Heart Ctr Hamburg, Dept Gen & Intervent Cardiol, Hamburg, Germany
[16] Univ Hosp Basel, Dept Heart Surg, Basel, Switzerland
[17] Univ Hosp Zurich, Emergency Dept, Zurich, Switzerland
[18] Univ Bern, Univ Hosp, Dept Cardiol, Inselspital, Bern, Switzerland
[19] Hosp Lachen, Dept Internal Med, Lachen, Switzerland
[20] Univ Hosp Basel, Lab Med, Basel, Switzerland
[21] Swiss Red Cross, Blood Transfus Ctr, Basel, Switzerland
基金
瑞士国家科学基金会;
关键词
brain natriuretic peptide; emergency service; hospital; NT-proBNP; syncope; troponin; EMERGENCY-DEPARTMENT; HEART-FAILURE; ATRIAL-FIBRILLATION; PROGNOSTIC VALUE; PREDICTOR; ASSAY; ASSOCIATION; VALIDATION; MANAGEMENT; OUTCOMES;
D O I
10.1161/CIRCULATIONAHA.118.038358
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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: 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: 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 (P<0.01). The diagnostic accuracy for cardiac syncope, as quantified by the area under the curve, was 0.77 to 0.78 (95% CI, 0.74-0.81) for all 4 biomarkers, and superior to EGSYS (area under the curve, 0.68 [95%-CI 0.65-0.71], P<0.001). Combining BNP/NT-proBNP with hs-cTnT/hs-cTnI further improved diagnostic accuracy to an area under the curve of 0.81 (P<0.01). BNP, NT-proBNP, hs-cTnT, and hs-cTnI cut-offs, achieving predefined thresholds for sensitivity and specificity (95%), allowed for rule-in or rule-out of approximate to 30% of all patients. A total of 450 major adverse cardiac events occurred during follow-up. The prognostic accuracy of BNP, NT-proBNP, hs-cTnI, and hs-cTnT for major adverse cardiac events was moderate-to-good (area under the curve, 0.75-0.79), superior to ROSE, OESIL, and SFSR, and inferior to CSRS. 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: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01548352.
引用
收藏
页码:2403 / 2418
页数:16
相关论文
共 49 条
[1]   Simple and effective confidence intervals for proportions and differences of proportions result from adding two successes and two failures [J].
Agresti, A ;
Caffo, B .
AMERICAN STATISTICIAN, 2000, 54 (04) :280-288
[2]   Prognostic Value of High-Sensitivity Troponin T in Chronic Heart Failure An Individual Patient Data Meta-Analysis [J].
Aimo, Alberto ;
Januzzi, James L., Jr. ;
Vergaro, Giuseppe ;
Ripoli, Andrea ;
Latini, Roberto ;
Masson, Serge ;
Magnoli, Michela ;
Anand, Inder S. ;
Cohn, Jay N. ;
Tavazzi, Luigi ;
Tognoni, Gianni ;
Gravning, Jorgen ;
Ueland, Thor ;
Nymo, Stale H. ;
Brunner-La Rocca, Hans-Peter ;
Genis, Antoni Bayes ;
Lupon, Josep ;
de Boer, Rudolf A. ;
Yoshihisa, Akiomi ;
Takeishi, Yasuchika ;
Egstrup, Michael ;
Gustafsson, Ida ;
Gaggin, Hanna K. ;
Eggers, Kai M. ;
Huber, Kurt ;
Tentzeris, Ioannis ;
Tang, Wai H. W. ;
Grodin, Justin ;
Passino, Claudio ;
Emdin, Michele .
CIRCULATION, 2018, 137 (03) :286-297
[3]   Prohormones in the Early Diagnosis of Cardiac Syncope [J].
Badertscher, Patrick ;
Nestelberger, Thomas ;
de Lavallaz, Jeanne du Fay ;
Morawiec, Beata ;
Kawecki, Damian ;
Miro, Oscar ;
Lopez, Beatriz ;
Martin-Sanchez, F. Javier ;
Bustamante, Jose ;
Geigy, Nicolas ;
Christ, Michael ;
Di Somma, Salvatore ;
Peacock, W. Frank ;
Cullen, Louise ;
Sarasin, Francois ;
Flores, Dayana ;
Tschuck, Michael ;
Boeddinghaus, Jasper ;
Twerenbold, Raphael ;
Wildi, Karin ;
Sabti, Zaid ;
Puelacher, Christian ;
Gimenez, Maria Rubini ;
Kozhuharov, Nikola ;
Shrestha, Samyut ;
Strebel, Ivo ;
Rentsch, Katharina ;
Keller, Dagmar I. ;
Poepping, Imke ;
Buser, Andreas ;
Kloos, Wanda ;
Lohrmann, Jens ;
Kuehne, Michael ;
Osswald, Stefan ;
Reichlin, Tobias ;
Mueller, Christian .
JOURNAL OF THE AMERICAN HEART ASSOCIATION, 2017, 6 (12)
[4]   Epidemiological characteristics and diagnostic approach in patients admitted to the emergency room for transient loss of consciousness: Group for Syncope Study in the Emergency Room (GESINUR) study [J].
Baron-Esquivias, Gonzalo ;
Martinez-Alday, Jesus ;
Martin, Alfonso ;
Moya, Angel ;
Garcia-Civera, Roberto ;
Paz Lopez-Chicharro, M. ;
Martin-Mendez, Maria ;
del Arco, Carmen ;
Laguna, Pedro .
EUROPACE, 2010, 12 (06) :869-876
[5]   Estimating and comparing time-dependent areas under receiver operating characteristic curves for censored event times with competing risks [J].
Blanche, Paul ;
Dartigues, Jean-Francois ;
Jacqmin-Gadda, Helene .
STATISTICS IN MEDICINE, 2013, 32 (30) :5381-5397
[6]   2018 ESC Guidelines for the diagnosis and management of syncope [J].
Brignole, Michele ;
Moya, Angel ;
de lange, Frederik J. ;
Deharo, Jean-Claude ;
Elliott, Perry M. ;
Fanciulli, Alessandra ;
Fedorowski, Artur ;
Furlan, Raffaello ;
Kenny, Rose Anne ;
Martin, Alfonso ;
Probst, Vincent ;
Reed, Matthew J. ;
Rice, Ciara P. ;
Sutton, Richard ;
Ungar, Andrea ;
van Dijk, J. Gert .
KARDIOLOGIA POLSKA, 2018, 76 (08) :1119-1198
[7]   Association of High-Sensitivity Cardiac Troponin I Concentration With Cardiac Outcomes in Patients With Suspected Acute Coronary Syndrome [J].
Chapman, Andrew R. ;
Lee, Kuan Ken ;
McAllister, David A. ;
Cullen, Louise ;
Greenslade, Jaimi H. ;
Parsonage, William ;
Worster, Andrew ;
Kavsak, Peter A. ;
Blankenberg, Stefan ;
Neumann, Johannes ;
Soerensen, Nils A. ;
Westermann, Dirk ;
Buijs, Madelon M. ;
Verdel, Gerard J. E. ;
Pickering, John W. ;
Than, Martin P. ;
Twerenbold, Raphael ;
Badertscher, Patrick ;
Sabti, Zaid ;
Mueller, Christian ;
Anand, Atul ;
Adamson, Philip ;
Strachan, Fiona E. ;
Ferry, Amy ;
Sandeman, Dennis ;
Gray, Alasdair ;
Body, Richard ;
Keevil, Brian ;
Carlton, Edward ;
Greaves, Kim ;
Korley, Frederick K. ;
Metkus, Thomas S. ;
Sandoval, Yader ;
Apple, Fred S. ;
Newby, David E. ;
Shah, Anoop S. V. ;
Mills, Nicholas L. .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2017, 318 (19) :1913-1924
[8]   Gender-specific risk stratification with B-type natriuretic peptide levels in patients with acute dyspnea - Insights from the B-type natriuretic peptide for Acute Shortness of Breath Evaluation Study [J].
Christ, Michael ;
Laule-Kilian, Kirsten ;
Hochholzer, Willibald ;
Klima, Theresia ;
Breidthardt, Tobias ;
Perruchoud, Andre P. ;
Mueller, Christian .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2006, 48 (09) :1808-1812
[9]   Diagnostic and Prognostic Value of High-sensitivity Cardiac Troponin T in Patients with Syncope [J].
Christ, Michael ;
Geier, Felicitas ;
Popp, Steffen ;
Singler, Katrin ;
Smolarsky, Alexander ;
Bertsch, Thomas ;
Mueller, Christian ;
Greve, Yvonne .
AMERICAN JOURNAL OF MEDICINE, 2015, 128 (02) :161-U173
[10]   B-Type Natriuretic Peptide Clinical Activation in Aortic Stenosis [J].
Clavel, Marie-Annick ;
Malouf, Joseph ;
Michelena, Hector I. ;
Suri, Rakesh M. ;
Jaffe, Allan S. ;
Mahoney, Douglas W. ;
Enriquez-Sarano, Maurice .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2014, 63 (19) :2016-2025