Why the study?
Even after recommended tests, 20-40% of syncopes remain of unknown origin, prompting the proposal of new biomarkers to resolve this diagnostic and prognostic uncertainty.
Do novel biomarkers improve the diagnosis and prognosis of syncope in patients older than 39 years?
Do novel biomarkers improve the diagnosis and prognosis of syncope in patients older than 39 years?
Current evidence does not support the routine use of novel biomarkers for the diagnosis and prognosis of syncope, highlighting the need for further research.
Answers are grounded in this paper and cite their sources.
Does not support routine use of novel biomarkers for syncope diagnosis or prognosis; leaves open their value pending targeted trials.
INTRODUCTION: Syncope is defined as a loss of consciousness, related to an insufficient blood flow to the brain. It could be caused by several conditions, mainly divided in cardiac and neurally mediated. However, even performing all the recommended tests, a wide percentage (20-40%) of syncopes is still classified as having an “unknown origin.” Some new biomarkers have been proposed to solve this uncertainty, and the aim of this review is to describe these biomarkers and the available relevant evidence.EVIDENCE ACQUISITION: A systematic research on PubMed Library was conducted to identify all the relevant literature published in the last five years; studies were considered eligible if they investigated diagnosis or prognosis of cardiogenic, vasovagal (VV) or orthostatic hypotension (OH) syncope by using a biomarker in patients older than 39 years. The biomarkers considered were: heart-type fatty acid binding protein (H-FABP), N-terminal fragment of the precursor of brain natriuretic peptide (NT-proBNP), C-terminal endothelin-1 precursor fragment (CT-proET1), human midregional pro-atrial natriuretic peptide (MR-proANP), copeptin, renin, cathecolamines, as diagnostic indicators; matrix metalloproteinase 7 (MMP-7), thrombomodulin (TM), myoglobin, (MB), T-cell immunoglobulin and mucin domain 1 (TIM-1), NT-proBNP, high-sensitivity cardiac troponin T (hscTnT), as prognosis indicators.EVIDENCE SYNTHESIS: To date, no studies have clearly defined either efficacy or effectiveness of new biomarkers to establish diagnosis and prognosis among patients with acute syncope.CONCLUSIONS: There is no evidence of the usefulness of biomarker in the diagnosis and prognosis of syncope; further studies are needed.
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Lalloni et al. (2020) studied this question.
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