Usefulness of brain natriuretic peptide as a marker for separating cardiac and noncardiac causes of syncope

doi:10.1016/j.amjcard.2003.09.048

The American Journal of Cardiology

Volume 93, Issue 2, 15 January 2004, Pages 228-230

https://doi.org/10.1016/j.amjcard.2003.09.048 Get rights and content

Abstract

We retrospectively evaluated the feasibility of measuring brain natriuretic peptide to identify cardiac syncope in 148 consecutive patients with syncope. Sixty-one patients with cardiac syncope were identified. A cut-off value of 40 pg/ml was used to determine the cardiac causes of syncope; the sensitivity and specificity for identification of cardiac syncope were 82% and 92%, respectively. Thus, measurement of brain natriuretic peptide concentrations may help confirm cardiac causes of syncope, and merits consideration for incorporation into the algorithm used to diagnose syncope.

References (8)

M. Linzer et al.
Diagnosing syncope. Part 1value of history, physical examination, and electrocardiography
Ann Intern Med
(1997)
M. Linzer et al.
Diagnosing syncope. Part 2unexplained syncope
Ann Intern Med
(1997)
N.B. Schiller et al.
Left ventricular volume from paired biplane two-dimensional echocardiography
Circulation
(1979)
D.D. Savage et al.
Epidemiologic features of isolated syncopethe Framingham study
Stroke
(1985)

There are more references available in the full text version of this article.

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Heart failure (HF) is a clinical syndrome characterized by symptoms and signs caused by structural and/or functional abnormalities of the heart that cause reduced cardiac output and/or elevated intracardiac pressures at rest or during exercise. Its prevalence and incidence are increasing and it is the leading cause of hospitalization in people over 65 years of age.
The new American and European guidelines for the management of HF emphasize that the measurement of natriuretic peptide (NP) concentrations constitutes a cornerstone of the diagnostic management of HF, and that the history, physical examination, electrocardiogram, and chest X-ray, complete the beginning of the HF diagnostic process. All these actions and diagnostic tests can be performed and requested from the primary care office.
The authors of this document, on behalf of the SEMERGEN Hypertension and Cardiovascular Disease Working Group, have reviewed the most recent scientific evidence related to the preventive diagnostic management of NP in patients with HF in primary care setting.
Canadian Cardiovascular Society Clinical Practice Update on the Assessment and Management of Syncope
2020, Canadian Journal of Cardiology
Syncope is a symptom that occurs in multiple settings and has a variety of underlying causes, ranging from benign to life threatening. Determining the underlying diagnosis and prognosis can be challenging and often results in an unstructured approach to evaluation, which is ineffective and costly. In this first ever document, the Canadian Cardiovascular Society (CCS) provides a clinical practice update on the assessment and management of syncope. It highlights similarities and differences between the 2017 American College of Cardiology/American Heart Association/Heart Rhythm Society and the 2018 European Society of Cardiology guidelines, draws on new data following a thorough review of medical literature, and takes the best available evidence and clinical experience to provide clinical practice tips. Where appropriate, a focus on a Canadian perspective is emphasized in order to illuminate larger international issues. This document represents the consensus of a Canadian panel comprised of multidisciplinary experts on this topic with a mandate to formulate disease-specific advice. The primary writing panel wrote the document, followed by peer review from the secondary writing panel. The CCS Guidelines Committee reviewed and approved the statement. The practice tips represent the consensus opinion of the primary writing panel authors, endorsed by the CCS. The CCS clinical practice update on the assessment and management of syncope focuses on epidemiology, the initial evaluation including risk stratification and disposition from the emergency department, initial diagnostic work-up, management of vasovagal syncope and orthostatic hypotension, and syncope and driving.
La syncope qui est un symptôme survenant dans nombreux contextes et présentant un grand nombre de causes sous-jacentes va de la syncope bénigne à la syncope mettant en danger la vie. La détermination du diagnostic sous-jacent et du pronostic peut être difficile et aboutit souvent à une approche d’évaluation non structurée, qui s’avère inefficace et coûteuse. Dans ce tout premier document, la Société canadienne de cardiologie (SCC) fournit l’actualisation des recommandations de pratique clinique pour l’évaluation et la prise en charge de la syncope. Il présente les similarités et les différences entre les recommandations de 2017 de l’American College of Cardiology, de l’American Heart Association et de la Heart Rhythm Society, et les recommandations de 2018 de la Société européenne de cardiologie, s’inspire des nouvelles données après un examen approfondi de la littérature médicale et puise dans les meilleures données scientifiques disponibles et l’expérience clinique pour donner des conseils de pratique clinique. Lorsque cela s’avère approprié, la perspective canadienne est mise en évidence dans le but d’éclairer les plus grands enjeux internationaux. Ce document représente le consensus d’un comité multidisciplinaire canadien composé d’experts sur ce sujet qui ont pour mandat de formuler des conseils propres à cette maladie. Le principal comité d’experts a écrit le document, et la revue par les pairs a été effectuée par le comité d’auteurs secondaire. Le comité des lignes directrices de la SCC a examiné et approuvé l’énoncé. Les conseils de pratique représentent le consensus des auteurs du comité principal et sont approuvés par la SCC. La mise à jour des recommandations de pratique clinique de la SCC pour l’évaluation et la prise en charge de la syncope est axée sur l’épidémiologie, l’évaluation initiale, notamment la stratification du risque et la disposition du service des urgences, le bilan diagnostique initial, la prise en charge de la syncope vasovagale et de l’hypotension orthostatique, ainsi que la syncope et la conduite automobile.
Risk Stratification of Older Adults Who Present to the Emergency Department With Syncope: The FAINT Score
2020, Annals of Emergency Medicine
Citation Excerpt :
Thus, we caution clinicians to not use this rule before external validation, and, if validated, to use it as a tool to justify the discharge of low-risk patients. Our results add to the increasing body of literature supporting the utility of B-type natriuretic peptide as a predictor of serious cardiac outcomes after an episode of syncope.6,58-63 An elevated NT-proBNP level had an odds ratio of 2.5, greater than that of any other clinical predictor we collected (Table 3).
Older adults with syncope are commonly treated in the emergency department (ED). We seek to derive a novel risk-stratification tool to predict 30-day serious cardiac outcomes.
We performed a prospective, observational study of older adults (≥60 years) with unexplained syncope or near syncope who presented to 11 EDs in the United States. Patients with a serious diagnosis identified in the ED were excluded. We collected clinical and laboratory data on all patients. Our primary outcome was 30-day all-cause mortality or serious cardiac outcome.
We enrolled 3,177 older adults with unexplained syncope or near syncope between April 2013 and September 2016. Mean age was 73 years (SD 9.0 years). The incidence of the primary outcome was 5.7% (95% confidence interval [CI] 4.9% to 6.5%). Using Bayesian logistic regression, we derived the FAINT score: history of heart failure, history of cardiac arrhythmia, initial abnormal ECG result, elevated pro B-type natriuretic peptide, and elevated high-sensitivity troponin T. A FAINT score of 0 versus greater than or equal to 1 had sensitivity of 96.7% (95% CI 92.9% to 98.8%) and specificity 22.2% (95% CI 20.7% to 23.8%), respectively. The FAINT score tended to be more accurate than unstructured physician judgment: area under the curve 0.704 (95% CI 0.669 to 0.739) versus 0.630 (95% CI 0.589 to 0.670).
Among older adults with syncope or near syncope of potential cardiac cause, a FAINT score of zero had a reasonably high sensitivity for excluding death and serious cardiac outcomes at 30 days. If externally validated, this tool could improve resource use for this common condition.
2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society
2017, Journal of the American College of Cardiology
2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society
2017, Heart Rhythm
2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope: Executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society
2017, Heart Rhythm

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Usefulness of brain natriuretic peptide as a marker for separating cardiac and noncardiac causes of syncope

Abstract

Diagnosing syncope. Part 1value of history, physical examination, and electrocardiography

Ann Intern Med

Diagnosing syncope. Part 2unexplained syncope

Ann Intern Med

Left ventricular volume from paired biplane two-dimensional echocardiography

Circulation

Epidemiologic features of isolated syncopethe Framingham study

Stroke