Prohormones in the Early Diagnosis of Cardiac Syncope.
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Badertscher P
Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.
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Nestelberger T
Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.
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de Lavallaz JDF
Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.
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Than M
GREAT Network, Rome, Italy.
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Morawiec B
GREAT Network, Rome, Italy.
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Kawecki D
GREAT Network, Rome, Italy.
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Miró Ò
GREAT Network, Rome, Italy.
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López B
GREAT Network, Rome, Italy.
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Martin-Sanchez FJ
GREAT Network, Rome, Italy.
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Bustamante J
GREAT Network, Rome, Italy.
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Geigy N
Department of Emergency Medicine, Hospital of Liestal, Switzerland.
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Christ M
GREAT Network, Rome, Italy.
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Di Somma S
GREAT Network, Rome, Italy.
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Peacock WF
GREAT Network, Rome, Italy.
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Cullen L
GREAT Network, Rome, Italy.
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Sarasin F
Emergency Department, Hôpitaux Universitaires de Genève, Switzerland.
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Flores D
Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.
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Tschuck M
Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.
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Boeddinghaus J
Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.
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Twerenbold R
Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.
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Wildi K
Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.
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Sabti Z
Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.
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Puelacher C
Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.
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Rubini Giménez M
Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.
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Kozhuharov N
Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.
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Shrestha S
Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.
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Strebel I
Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.
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Rentsch K
Laboratory Medicine, University Hospital Basel University of Basel, Switzerland.
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Keller DI
Emergency Department, University Hospital Zurich, Zurich, Switzerland.
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Poepping I
Department of Internal Medicine, Hospital of Lachen, Switzerland.
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Buser A
Department of Hematology, University Hospital Basel University of Basel, Switzerland.
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Kloos W
Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.
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Lohrmann J
Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.
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Kuehne M
Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.
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Osswald S
Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.
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Reichlin T
Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland.
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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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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.
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Language
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Open access status
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gold
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Identifiers
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Persistent URL
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https://sonar.ch/global/documents/47458
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