Key result
Patients with cardiac syncope had significantly higher concentrations of NT-proBNP compared to patients with reflex syncope (448.7 vs 68.2 pg/ml; p < 0.0001).
Why the study?
Does NT-proBNP concentration and ECG monitoring differentiate cardiac from reflex syncope in patients presenting with syncope?
Cohort (n=100)
No
Does NT-proBNP concentration and ECG monitoring differentiate cardiac from reflex syncope in patients presenting with syncope?
Absolute Event Rate: 448.7% vs 68.2%
p-value: p=<0.0001
NT-proBNP concentrations are significantly elevated in patients with cardiac syncope compared to reflex syncope, providing diagnostic value when resting ECG is inconclusive.
May aid differentiation of cardiac from reflex syncope when ECG inconclusive; hypothesis-generating and requires prospective validation before clinical use.
Kontext: Synkopa je dĹŻvodem pro 1-6 % hospitalizacĂ. EvropskĂŠ i americkĂŠ doporuÄenĂŠ postupy pro lĂŠÄbu synkopy uvĂĄdÄjĂ dvanĂĄctisvodovĂ˝ EKG zĂĄznam jako souÄĂĄst vyĹĄetĹenĂ vĹĄech pacientĹŻ s nevysvÄtlenou ztrĂĄtou vÄdomĂ.CĂle: CĂlem tĂŠto studie bylo posoudit vĂ˝znam EKG, 24hodinovĂŠho holterovskĂŠho monitorovĂĄnĂ EKG a koncentracĂ N-terminĂĄlnĂho fragmentu natriuretickĂŠho propeptidu typu B (NT-proBNP) pĹi rozliĹĄovĂĄnĂ pacientĹŻ s kardiĂĄlnĂ a reflexnÄ zprostĹedkovanou synkopou.Metody: Za poslednĂ tĹi roky jsme vyĹĄetĹili 100 pacientĹŻ (56 muŞů) ve vÄku 18-77 let s reflexnÄ zprostĹedkovanou nebo kardiĂĄlnĂ synkopou. Byly sledovĂĄny nĂĄsledujĂcĂ faktory: vÄk, pohlavĂ, systolickĂ˝ a diastolickĂ˝ tlak a pĹĂtomnost kardiovaskulĂĄrnĂho onemocnÄnĂ. Mimoto jsme hodnotili zĂĄkladnĂ parametry klidovĂŠho EKG zĂĄznamu a 24hodinovĂŠho holterovskĂŠho EKG monitorovĂĄnĂ a koncentrace NT-proBNP v diferenciĂĄlnĂ diagnostice synkopy.VĂ˝sledky: Pacienti s reflexnĂ synkopou byli mladĹĄĂ neĹž pacienti s kardiĂĄlnĂ synkopou (44,4 ± 16,5 vs. 60,8 ± 12,6 roku; p < 0,001). PatologickĂ˝ klidovĂ˝ 12svodovĂ˝ EKG zĂĄznam byl ÄastÄji nalezen ve skupinÄ s kardiogennĂm typem synkopy - 12 (24 %) vs. 8 (16 %). ÄtyĹiadvacetihodinovĂŠ holterovskĂŠ EKG monitorovĂĄnĂ neprokĂĄzalo statisticky vĂ˝znamnĂ˝ rozdĂl mezi obÄma skupinami v minimĂĄlnĂ, prĹŻmÄrnĂŠ a maximĂĄlnĂ srdeÄnĂ frekvenci. Statisticky vĂ˝znamnĂŠ rozdĂly mezi hodnocenĂ˝mi skupinami byly nalezeny ve vĂ˝skytu komorovĂ˝ch a supraventrikulĂĄrnĂch arytmiĂ. Pacienti s kardiĂĄlnĂ synkopou mÄli vĂ˝znamnÄ vyĹĄĹĄĂ koncentrace NT-proBNP neĹž pacienti s reflexnÄ zprostĹedkovanou synkopou (448,7 ± 212,2 vs. 68,2 ± 64,1; p < 0,0001).ZĂĄvÄry: U pacientĹŻ s kardiogennĂm mechanismem synkopy je pĹĂtomna zvýťenĂĄ koncentrace NT-proBNP, pĹestoĹže klidovĂ˝ EKG zĂĄznam nemĂĄ v tomto smyslu jednoznaÄnÄ vĂ˝povÄdnĂ hodnotu.
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Stryjewski et al. (2015) conducted a cohort in Syncope (n=100). Cardiac syncope vs. Reflex syncope was evaluated on NT-proBNP concentration (pg/ml) (p=<0.0001). Patients with cardiac syncope had significantly higher concentrations of NT-proBNP compared to patients with reflex syncope (448.7 vs 68.2 pg/ml; p < 0.0001).
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