Journal article

Prohormones in the Early Diagnosis of Cardiac Syncope.

  • Badertscher P Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.
  • Nestelberger T Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.
  • de Lavallaz JDF Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.
  • Than M GREAT Network, Rome, Italy.
  • Morawiec B GREAT Network, Rome, Italy.
  • Kawecki D GREAT Network, Rome, Italy.
  • Miró Ò GREAT Network, Rome, Italy.
  • López B GREAT Network, Rome, Italy.
  • Martin-Sanchez FJ GREAT Network, Rome, Italy.
  • Bustamante J GREAT Network, Rome, Italy.
  • Geigy N Department of Emergency Medicine, Hospital of Liestal, Switzerland.
  • Christ M GREAT Network, Rome, Italy.
  • Di Somma S GREAT Network, Rome, Italy.
  • Peacock WF GREAT Network, Rome, Italy.
  • Cullen L GREAT Network, Rome, Italy.
  • Sarasin F Emergency Department, Hôpitaux Universitaires de Genève, Switzerland.
  • Flores D Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.
  • Tschuck M Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.
  • Boeddinghaus J Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.
  • Twerenbold R Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.
  • Wildi K Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.
  • Sabti Z Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.
  • Puelacher C Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.
  • Rubini Giménez M Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.
  • Kozhuharov N Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.
  • Shrestha S Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.
  • Strebel I Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.
  • Rentsch K Laboratory Medicine, University Hospital Basel University of Basel, Switzerland.
  • Keller DI Emergency Department, University Hospital Zurich, Zurich, Switzerland.
  • Poepping I Department of Internal Medicine, Hospital of Lachen, Switzerland.
  • Buser A Department of Hematology, University Hospital Basel University of Basel, Switzerland.
  • Kloos W Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.
  • Lohrmann J Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.
  • Kuehne M Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.
  • Osswald S Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.
  • Reichlin T Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.
  • Mueller C Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland christian.mueller@usb.ch.
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  • 2018-02-10
Published in:
  • Journal of the American Heart Association. - 2017
English BACKGROUND
The early detection of cardiac syncope is challenging. We aimed to evaluate the diagnostic value of 4 novel prohormones, quantifying different neurohumoral pathways, possibly involved in the pathophysiological features of cardiac syncope: midregional-pro-A-type natriuretic peptide (MRproANP), C-terminal proendothelin 1, copeptin, and midregional-proadrenomedullin.


METHODS AND RESULTS
We prospectively enrolled unselected patients presenting with syncope to the emergency department (ED) in a diagnostic multicenter study. ED probability of cardiac syncope was quantified by the treating ED physician using a visual analogue scale. Prohormones were measured in a blinded manner. Two independent cardiologists adjudicated the final diagnosis on the basis of all clinical information, including 1-year follow-up. Among 689 patients, cardiac syncope was the adjudicated final diagnosis in 125 (18%). Plasma concentrations of MRproANP, C-terminal proendothelin 1, copeptin, and midregional-proadrenomedullin were all significantly higher in patients with cardiac syncope compared with patients with other causes (P<0.001). The diagnostic accuracies for cardiac syncope, as quantified by the area under the curve, were 0.80 (95% confidence interval [CI], 0.76-0.84), 0.69 (95% CI, 0.64-0.74), 0.58 (95% CI, 0.52-0.63), and 0.68 (95% CI, 0.63-0.73), respectively. In conjunction with the ED probability (0.86; 95% CI, 0.82-0.90), MRproANP, but not the other prohormone, improved the area under the curve to 0.90 (95% CI, 0.87-0.93), which was significantly higher than for the ED probability alone (P=0.003). An algorithm to rule out cardiac syncope combining an MRproANP level of <77 pmol/L and an ED probability of <20% had a sensitivity and a negative predictive value of 99%.


CONCLUSIONS
The use of MRproANP significantly improves the early detection of cardiac syncope among unselected patients presenting to the ED with syncope.


CLINICAL TRIAL REGISTRATION
URL: http://www.clinicaltrials.gov. Unique identifier: NCT01548352.
Language
  • English
Open access status
gold
Identifiers
Persistent URL
https://sonar.ch/global/documents/47458
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