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Zimmermann, T; Du Fay De Lavallaz, J; Badertscher, P; Puelacher, C; Nestelberger, T; Boeddinghaus, J; Walter, J E; Wussler, D; Twerenbold, R; Kuehne, M; Reichlin, T; Mueller, C

P5673Combination of high-sensitivity cardiac troponin and B-Type natriuretic peptide (BNP) for diagnosis and risk-stratification of syncope

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  • Media type: E-Article
  • Title: P5673Combination of high-sensitivity cardiac troponin and B-Type natriuretic peptide (BNP) for diagnosis and risk-stratification of syncope
  • Contributor: Zimmermann, T; Du Fay De Lavallaz, J; Badertscher, P; Puelacher, C; Nestelberger, T; Boeddinghaus, J; Walter, J E; Wussler, D; Twerenbold, R; Kuehne, M; Reichlin, T; Mueller, C
  • Published in: European Heart Journal
  • Published: Oxford University Press (OUP), 2019
  • Language: English
  • DOI: 10.1093/eurheartj/ehz746.0615
  • ISSN: 0195-668X; 1522-9645
  • Keywords: Cardiology and Cardiovascular Medicine
  • Abstract: <jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>While high-sensitivity cardiac troponin (hs-cTn) and B-Type natriuretic peptide (BNP) have been assessed separately for the diagnosis and risk-stratification of patients with syncope, their combined accuracy is unknown.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>We assessed the diagnostic and prognostic accuracy of the combination of hs-cTnI and BNP in a prospective international multicenter study enrolling patients 40 years and older presenting with syncope to the emergency department (ED). Hs-cTnI (Architect) and BNP (Architect) concentrations were measured in a blinded fashion. Cardiac syncope, as adjudicated by two independent physicians using all available clinical information including one year follow-up, was the diagnostic endpoint. MACE were defined as death, resuscitation, life-threatening arrhythmia, implantation of a pacemaker or implantable cardioverter defibrillator (ICD), acute myocardial infarction, pulmonary embolism, stroke/transient ischemic attack (TIA), intracranial bleeding or valvular intervention. Patients were classified in three risk groups (low (&lt;10%), medium (10–30%), high (&gt;30%)) for cardiac syncope based on hs-cTnI and BNP levels.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Among 1533 patients, cardiac syncope was the adjudicated final diagnosis in 233 (15.2%). Hs-cTnI and BNP concentrations both remained independent predictors of cardiac syncope in multivariable models. The diagnostic accuracy of the combination hs-cTnI/BNP for cardiac syncope was good with an area under the curve (AUC) of 0.81 (95%-CI 0.78–0.84) and significantly better than each biomarker separately or a set of clinical variables (each p&lt;0.001). The classification of patients in three risk groups, depending on the probability for cardiac syncope based on their hs-cTnI and BNP values, translated well in predictions for MACE (AUC 0.79, 95%-CI 0.77–0.82) and death (AUC 0.78, 95%-CI 0.74–0.82) at 2 years follow-up. Based on these results, we designed a visual tool allowing convenient patient-specific diagnostic and prognostic risk evaluation based solely on hs-cTnI and BNP concentrations (Figure).</jats:p> <jats:p>Risk stratification based on hs-cTnI/BNP</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>The combination hs-cTnI/BNP may have clinical utility in patients presenting to the ED with syncope as it allows good diagnostic as well as prognostic discrimination.</jats:p> </jats:sec> <jats:sec> <jats:title>Acknowledgement/Funding</jats:title> <jats:p>Swiss National Science Foundation, Swiss Heart Foundation, Cardiovascular Research Foundation Basel, University Basel</jats:p> </jats:sec>
  • Description: <jats:title>Abstract</jats:title>
    <jats:sec>
    <jats:title>Background</jats:title>
    <jats:p>While high-sensitivity cardiac troponin (hs-cTn) and B-Type natriuretic peptide (BNP) have been assessed separately for the diagnosis and risk-stratification of patients with syncope, their combined accuracy is unknown.</jats:p>
    </jats:sec>
    <jats:sec>
    <jats:title>Methods</jats:title>
    <jats:p>We assessed the diagnostic and prognostic accuracy of the combination of hs-cTnI and BNP in a prospective international multicenter study enrolling patients 40 years and older presenting with syncope to the emergency department (ED). Hs-cTnI (Architect) and BNP (Architect) concentrations were measured in a blinded fashion. Cardiac syncope, as adjudicated by two independent physicians using all available clinical information including one year follow-up, was the diagnostic endpoint. MACE were defined as death, resuscitation, life-threatening arrhythmia, implantation of a pacemaker or implantable cardioverter defibrillator (ICD), acute myocardial infarction, pulmonary embolism, stroke/transient ischemic attack (TIA), intracranial bleeding or valvular intervention. Patients were classified in three risk groups (low (&lt;10%), medium (10–30%), high (&gt;30%)) for cardiac syncope based on hs-cTnI and BNP levels.</jats:p>
    </jats:sec>
    <jats:sec>
    <jats:title>Results</jats:title>
    <jats:p>Among 1533 patients, cardiac syncope was the adjudicated final diagnosis in 233 (15.2%). Hs-cTnI and BNP concentrations both remained independent predictors of cardiac syncope in multivariable models. The diagnostic accuracy of the combination hs-cTnI/BNP for cardiac syncope was good with an area under the curve (AUC) of 0.81 (95%-CI 0.78–0.84) and significantly better than each biomarker separately or a set of clinical variables (each p&lt;0.001). The classification of patients in three risk groups, depending on the probability for cardiac syncope based on their hs-cTnI and BNP values, translated well in predictions for MACE (AUC 0.79, 95%-CI 0.77–0.82) and death (AUC 0.78, 95%-CI 0.74–0.82) at 2 years follow-up. Based on these results, we designed a visual tool allowing convenient patient-specific diagnostic and prognostic risk evaluation based solely on hs-cTnI and BNP concentrations (Figure).</jats:p>
    <jats:p>Risk stratification based on hs-cTnI/BNP</jats:p>
    </jats:sec>
    <jats:sec>
    <jats:title>Conclusion</jats:title>
    <jats:p>The combination hs-cTnI/BNP may have clinical utility in patients presenting to the ED with syncope as it allows good diagnostic as well as prognostic discrimination.</jats:p>
    </jats:sec>
    <jats:sec>
    <jats:title>Acknowledgement/Funding</jats:title>
    <jats:p>Swiss National Science Foundation, Swiss Heart Foundation, Cardiovascular Research Foundation Basel, University Basel</jats:p>
    </jats:sec>
  • Footnote:
  • Access State: Open Access