NT-pro-BNP for differential diagnosis in patients with syncope

• Published in: International journal of cardiology Vol. 133; no. 1; pp. 51 - 54
• Main Authors: Pfister, Roman, Diedrichs, Holger, Larbig, Robert, Erdmann, Erland, Schneider, Christian A
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 20.03.2009; Elsevier
• Subjects: Aged; Biological and medical sciences; Biomarkers - blood; Cardiac; Cardiology. Vascular system; Cardiovascular; Coronary Angiography; Diagnosis; Diagnosis, Differential; Disorders of higher nervous function. Focal brain diseases. Central vestibular syndrome and deafness. Brain stem syndromes; Echocardiography; Electrocardiography, Ambulatory; Electrophysiologic Techniques, Cardiac; Emergency Service, Hospital; Exercise Test; Female; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Male; Medical sciences; Middle Aged; Natriuretic Peptide, Brain - blood; Nervous system (semeiology, syndromes); Neurology; NT-pro-BNP; Peptide Fragments - blood; Pilot Projects; Predictive Value of Tests; ROC Curve; Sensitivity and Specificity; Statistics, Nonparametric; Syncope; Syncope - diagnosis; Syncope - etiology; Telemetry; NT-pro-BNP; Diagnosis; Syncope; Cardiac; Heart; Human; Brain natriuretic peptide; Nervous system diseases; Consciousness impairment; Cardiovascular disease; Differential diagnostic; Neurological disorder; Cardiology
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2007.11.082

Abstract Background Syncope is a frequent diagnosis and establishing the etiology is often elaborate. Aim of this study was to evaluate the diagnostic value of NT-pro-BNP in patients with syncope. Methods NT-pro-BNP was assessed in 61 patients admitted for syncope to our cardiological department of the University hospital Cologne, Germany. Results 16 patients (26.2%) had neurally-mediated syncope, 9 (14.8%) had orthostatic syncope, 12 (19.7%) had cardiac arrhythmias, 8 (13.1%) had structural cardiac/cardiopulmonary disease, 2 patients (3.3%) had cerebrovascular disease, 3 (4.9%) had non-syncopal attack and in 11 (18%) patients the cause remained unknown. Patients with cardiac syncope had significantly higher NT-pro-BNP values (514 IQR 286–1154 pg/ml) than patients with non-cardiac cause (182 IQR 70–378 pg/ml, p = 0.001). NT-pro-BNP at a cut-off of 164 pg/ml identified patients with cardiac syncope and patients requiring interventional cardiological therapy with a sensitivity of 90% and 93.8%, a specificity of 48.8% and 46.7% and a negative predictive value of 91% and 95.5%. NT-pro-BNP pre-testing could save 45% of the Holter ECGs, 83% of the telemetry monitoring, 47% of stress tests, 49% of echocardiographies, 67% of coronary angiographies and 43% of electrophysiological examinations. Conclusions NT-pro-BNP assessment was helpful in differentiating cardiac from non-cardiac syncope. Further studies are needed to define the role of NT-pro-BNP in the diagnostic algorithm of syncope.