B-Type Natriuretic Peptides and Cardiac Troponins for Diagnosis and Risk-Stratification of Syncope
Key result
BNP, NT-proBNP, hs-cTnT, and hs-cTnI concentrations demonstrated good diagnostic accuracy for cardiac syncope (AUC 0.77-0.78), superior to the EGSYS clinical score (AUC 0.68, P<0.001).
Why the study?
The utility of BNP, NT-proBNP, and hs-cTn concentrations for the diagnosis and risk stratification of syncope was incompletely understood.
Does the measurement of BNP, NT-proBNP, hs-cTnT, and hs-cTnI improve the diagnosis of cardiac syncope and risk-stratification for major adverse cardiac events compared to clinical scores in patients >45 years old presenting to the emergency department with syncope?
Population
1538 patients >45-years old presenting with syncope to the emergency department
Comparison
BNP, NT-proBNP, hs-cTnT, and hs-cTnI vs clinical risk scores
Design
Prospective blinded multicenter diagnostic study
Follow-up
30 and 720 days
Authors
Discussion
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Member takes
Implication
May aid cardiac syncope diagnosis in older ED patients; hypothesis-generating for MACE risk stratification pending prospective trials.
Study Design
Type
Observational (n=1,538)
Blinding
Blinded
Multicenter
Yes
Structured PICO
Does the measurement of BNP, NT-proBNP, hs-cTnT, and hs-cTnI improve the diagnosis of cardiac syncope and risk-stratification for major adverse cardiac events compared to clinical scores in patients >45 years old presenting to the emergency department with syncope?
P
Population
1,538 patients >45 years old presenting with syncope to the emergency department, evaluated for diagnostic and prognostic accuracy of cardiac biomarkers over 720 days.
E
Exposure
Measurement of BNP, NT-proBNP, hs-cTnT, and hs-cTnI concentrations
C
Comparator
Clinical assessment scores: EGSYS (Evaluation of Guidelines in Syncope Study) for diagnosis; ROSE, OESIL, SFSR, and CSRS for prognosis
O
Outcome
Diagnostic end point: Cardiac syncope (adjudicated by 2 physicians based on cardiac work-up and 1-year follow-up). Prognostic end points: Death and major adverse cardiac events at 30 and 720 days.composite
Main Result
Effect estimate: AUC 0.77-0.78 (95% CI 0.74-0.81)
p-value: p=<0.001
BNP, NT-proBNP, hs-cTnT, and hs-cTnI provide superior diagnostic accuracy for cardiac syncope compared to the EGSYS score and offer moderate-to-good prognostic value for major adverse cardiac events in emergency department patients >45 years old.
Cite This Study
Lavallaz et al. (2019) conducted an observational in Syncope (n=1,538). BNP, NT-proBNP, hs-cTnT, and hs-cTnI vs. Clinical assessments (EGSYS, ROSE, OESIL, SFSR, CSRS) was evaluated on Cardiac syncope (AUC 0.77-0.78, 95% CI 0.74-0.81, p=<0.001). BNP, NT-proBNP, hs-cTnT, and hs-cTnI concentrations demonstrated good diagnostic accuracy for cardiac syncope (AUC 0.77-0.78), superior to the EGSYS clinical score (AUC 0.68, P<0.001).