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B-Type Natriuretic Peptides and Cardiac Troponins for Diagnosis and Risk-Stratification of Syncope

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B-Type Natriuretic Peptides and Cardiac Troponins for Diagnosis and Risk-Stratification of Syncope. / du Fay de Lavallaz, Jeanne; Badertscher, Patrick; Nestelberger, Thomas; Zimmermann, Tobias; Miró, Òscar; Salgado, Emilio; Christ, Michael; Geigy, Nicolas; Cullen, Louise; Than, Martin; Martin-Sanchez, F Javier; Di Somma, Salvatore; Peacock, W Frank; Morawiec, Beata; Walter, Joan; Twerenbold, Raphael; Puelacher, Christian; Wussler, Desiree; Boeddinghaus, Jasper; Koechlin, Luca; Strebel, Ivo; Keller, Dagmar I; Lohrmann, Jens; Michou, Eleni; Kühne, Michael; Reichlin, Tobias; Mueller, Christian.

In: CIRCULATION, 25.02.2019.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

du Fay de Lavallaz, J, Badertscher, P, Nestelberger, T, Zimmermann, T, Miró, Ò, Salgado, E, Christ, M, Geigy, N, Cullen, L, Than, M, Martin-Sanchez, FJ, Di Somma, S, Peacock, WF, Morawiec, B, Walter, J, Twerenbold, R, Puelacher, C, Wussler, D, Boeddinghaus, J, Koechlin, L, Strebel, I, Keller, DI, Lohrmann, J, Michou, E, Kühne, M, Reichlin, T & Mueller, C 2019, 'B-Type Natriuretic Peptides and Cardiac Troponins for Diagnosis and Risk-Stratification of Syncope', CIRCULATION. https://doi.org/10.1161/CIRCULATIONAHA.118.038358

APA

du Fay de Lavallaz, J., Badertscher, P., Nestelberger, T., Zimmermann, T., Miró, Ò., Salgado, E., Christ, M., Geigy, N., Cullen, L., Than, M., Martin-Sanchez, F. J., Di Somma, S., Peacock, W. F., Morawiec, B., Walter, J., Twerenbold, R., Puelacher, C., Wussler, D., Boeddinghaus, J., ... Mueller, C. (2019). B-Type Natriuretic Peptides and Cardiac Troponins for Diagnosis and Risk-Stratification of Syncope. CIRCULATION. https://doi.org/10.1161/CIRCULATIONAHA.118.038358

Vancouver

du Fay de Lavallaz J, Badertscher P, Nestelberger T, Zimmermann T, Miró Ò, Salgado E et al. B-Type Natriuretic Peptides and Cardiac Troponins for Diagnosis and Risk-Stratification of Syncope. CIRCULATION. 2019 Feb 25. https://doi.org/10.1161/CIRCULATIONAHA.118.038358

Bibtex

@article{cc82edd5c8634314a9d67c18b5c3fb4d,
title = "B-Type Natriuretic Peptides and Cardiac Troponins for Diagnosis and Risk-Stratification of Syncope",
abstract = "BACKGROUND: The utility of B-type Natriuretic Peptide (BNP), N-terminal proBNP (NT-proBNP), and high-sensitivity cardiac troponin (hs-cTn) concentrations for diagnosis and risk-stratification of syncope is incompletely understood.METHODS: We evaluated the diagnostic and prognostic accuracy of BNP, NT-proBNP, hs-cTnT, and hs-cTnI concentrations, alone and against the ones of clinical assessments, in patients >45years presenting with syncope to the emergency department (ED) in a prospective diagnostic multicenter study. BNP, NT-proBNP, hs-cTnT and hs-cTnI concentrations were measured in a blinded fashion. Cardiac syncope, as adjudicated by two physicians based on all information available including cardiac work-up and 1-year follow-up, was the diagnostic endpoint. The EGSYS, a syncope-specific diagnostic score, served as the diagnostic comparator. Death and MACE at 30 and 720 days were the prognostic endpoints. MACE were defined as death, cardiopulmonary resuscitation, life-threatening arrhythmia, implantation of pacemaker/implantable cardioverter defibrillator, acute myocardial infarction, pulmonary embolism, stroke/transient ischemic attack, intracranial bleeding or valvular surgery. The ROSE, OESIL, San Fransisco Syncope Rule (SFSR) and Canadian Syncope Risk Score (CSRS) served as the prognostic comparators.RESULTS: Among 1538 patients eligible for diagnostic assessment, cardiac syncope was the adjudicated diagnosis in 234 patients (15.2%). BNP, NT-proBNP, hs-cTnT, and hs-cTnI were significantly higher in cardiac syncope vs. other causes (p<0.01). The diagnostic accuracy for cardiac syncope, as quantified by the area under the curve (AUC), was 0.77-0.78 (95% confidence interval (CI) 0.74-0.81) for all four biomarkers, and superior to the one of EGSYS (AUC 0.68 [95%-CI 0.65-0.71], p<0.001). Combining BNP/NT-proBNP with hs-cTnT/hs-cTnI further improved diagnostic accuracy to an AUC of 0.81 (p<0.01). BNP, NT-proBNP, hs-cTnT, and hs-cTnI cut-offs, achieving pre-defined thresholds for sensitivity and specificity (95%), allowed for rule-in or rule-out of ~30% of all patients. A total of 450 MACE occurred during follow-up. The prognostic accuracy of BNP, NT-proBNP, hs-cTnI, and hs-cTnT for MACE was moderate-to-good (AUC 0.75-0.79), superior to ROSE, OESIL and SFSR, and inferior to the CSRS.CONCLUSIONS: BNP, NT-proBNP, hs-cTnT, and hs-cTnI concentrations provide useful diagnostic and prognostic information in ED patients with syncope.CLINICAL TRIAL REGISTRATION: URL: https://clinicaltrials.gov Unique Identifier: NCT01548352.",
author = "{du Fay de Lavallaz}, Jeanne and Patrick Badertscher and Thomas Nestelberger and Tobias Zimmermann and {\`O}scar Mir{\'o} and Emilio Salgado and Michael Christ and Nicolas Geigy and Louise Cullen and Martin Than and Martin-Sanchez, {F Javier} and {Di Somma}, Salvatore and Peacock, {W Frank} and Beata Morawiec and Joan Walter and Raphael Twerenbold and Christian Puelacher and Desiree Wussler and Jasper Boeddinghaus and Luca Koechlin and Ivo Strebel and Keller, {Dagmar I} and Jens Lohrmann and Eleni Michou and Michael K{\"u}hne and Tobias Reichlin and Christian Mueller",
year = "2019",
month = feb,
day = "25",
doi = "10.1161/CIRCULATIONAHA.118.038358",
language = "English",
journal = "CIRCULATION",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",

}

RIS

TY - JOUR

T1 - B-Type Natriuretic Peptides and Cardiac Troponins for Diagnosis and Risk-Stratification of Syncope

AU - du Fay de Lavallaz, Jeanne

AU - Badertscher, Patrick

AU - Nestelberger, Thomas

AU - Zimmermann, Tobias

AU - Miró, Òscar

AU - Salgado, Emilio

AU - Christ, Michael

AU - Geigy, Nicolas

AU - Cullen, Louise

AU - Than, Martin

AU - Martin-Sanchez, F Javier

AU - Di Somma, Salvatore

AU - Peacock, W Frank

AU - Morawiec, Beata

AU - Walter, Joan

AU - Twerenbold, Raphael

AU - Puelacher, Christian

AU - Wussler, Desiree

AU - Boeddinghaus, Jasper

AU - Koechlin, Luca

AU - Strebel, Ivo

AU - Keller, Dagmar I

AU - Lohrmann, Jens

AU - Michou, Eleni

AU - Kühne, Michael

AU - Reichlin, Tobias

AU - Mueller, Christian

PY - 2019/2/25

Y1 - 2019/2/25

N2 - BACKGROUND: The utility of B-type Natriuretic Peptide (BNP), N-terminal proBNP (NT-proBNP), and high-sensitivity cardiac troponin (hs-cTn) concentrations for diagnosis and risk-stratification of syncope is incompletely understood.METHODS: We evaluated the diagnostic and prognostic accuracy of BNP, NT-proBNP, hs-cTnT, and hs-cTnI concentrations, alone and against the ones of clinical assessments, in patients >45years presenting with syncope to the emergency department (ED) in a prospective diagnostic multicenter study. BNP, NT-proBNP, hs-cTnT and hs-cTnI concentrations were measured in a blinded fashion. Cardiac syncope, as adjudicated by two physicians based on all information available including cardiac work-up and 1-year follow-up, was the diagnostic endpoint. The EGSYS, a syncope-specific diagnostic score, served as the diagnostic comparator. Death and MACE at 30 and 720 days were the prognostic endpoints. MACE were defined as death, cardiopulmonary resuscitation, life-threatening arrhythmia, implantation of pacemaker/implantable cardioverter defibrillator, acute myocardial infarction, pulmonary embolism, stroke/transient ischemic attack, intracranial bleeding or valvular surgery. The ROSE, OESIL, San Fransisco Syncope Rule (SFSR) and Canadian Syncope Risk Score (CSRS) served as the prognostic comparators.RESULTS: Among 1538 patients eligible for diagnostic assessment, cardiac syncope was the adjudicated diagnosis in 234 patients (15.2%). BNP, NT-proBNP, hs-cTnT, and hs-cTnI were significantly higher in cardiac syncope vs. other causes (p<0.01). The diagnostic accuracy for cardiac syncope, as quantified by the area under the curve (AUC), was 0.77-0.78 (95% confidence interval (CI) 0.74-0.81) for all four biomarkers, and superior to the one of EGSYS (AUC 0.68 [95%-CI 0.65-0.71], p<0.001). Combining BNP/NT-proBNP with hs-cTnT/hs-cTnI further improved diagnostic accuracy to an AUC of 0.81 (p<0.01). BNP, NT-proBNP, hs-cTnT, and hs-cTnI cut-offs, achieving pre-defined thresholds for sensitivity and specificity (95%), allowed for rule-in or rule-out of ~30% of all patients. A total of 450 MACE occurred during follow-up. The prognostic accuracy of BNP, NT-proBNP, hs-cTnI, and hs-cTnT for MACE was moderate-to-good (AUC 0.75-0.79), superior to ROSE, OESIL and SFSR, and inferior to the CSRS.CONCLUSIONS: BNP, NT-proBNP, hs-cTnT, and hs-cTnI concentrations provide useful diagnostic and prognostic information in ED patients with syncope.CLINICAL TRIAL REGISTRATION: URL: https://clinicaltrials.gov Unique Identifier: NCT01548352.

AB - BACKGROUND: The utility of B-type Natriuretic Peptide (BNP), N-terminal proBNP (NT-proBNP), and high-sensitivity cardiac troponin (hs-cTn) concentrations for diagnosis and risk-stratification of syncope is incompletely understood.METHODS: We evaluated the diagnostic and prognostic accuracy of BNP, NT-proBNP, hs-cTnT, and hs-cTnI concentrations, alone and against the ones of clinical assessments, in patients >45years presenting with syncope to the emergency department (ED) in a prospective diagnostic multicenter study. BNP, NT-proBNP, hs-cTnT and hs-cTnI concentrations were measured in a blinded fashion. Cardiac syncope, as adjudicated by two physicians based on all information available including cardiac work-up and 1-year follow-up, was the diagnostic endpoint. The EGSYS, a syncope-specific diagnostic score, served as the diagnostic comparator. Death and MACE at 30 and 720 days were the prognostic endpoints. MACE were defined as death, cardiopulmonary resuscitation, life-threatening arrhythmia, implantation of pacemaker/implantable cardioverter defibrillator, acute myocardial infarction, pulmonary embolism, stroke/transient ischemic attack, intracranial bleeding or valvular surgery. The ROSE, OESIL, San Fransisco Syncope Rule (SFSR) and Canadian Syncope Risk Score (CSRS) served as the prognostic comparators.RESULTS: Among 1538 patients eligible for diagnostic assessment, cardiac syncope was the adjudicated diagnosis in 234 patients (15.2%). BNP, NT-proBNP, hs-cTnT, and hs-cTnI were significantly higher in cardiac syncope vs. other causes (p<0.01). The diagnostic accuracy for cardiac syncope, as quantified by the area under the curve (AUC), was 0.77-0.78 (95% confidence interval (CI) 0.74-0.81) for all four biomarkers, and superior to the one of EGSYS (AUC 0.68 [95%-CI 0.65-0.71], p<0.001). Combining BNP/NT-proBNP with hs-cTnT/hs-cTnI further improved diagnostic accuracy to an AUC of 0.81 (p<0.01). BNP, NT-proBNP, hs-cTnT, and hs-cTnI cut-offs, achieving pre-defined thresholds for sensitivity and specificity (95%), allowed for rule-in or rule-out of ~30% of all patients. A total of 450 MACE occurred during follow-up. The prognostic accuracy of BNP, NT-proBNP, hs-cTnI, and hs-cTnT for MACE was moderate-to-good (AUC 0.75-0.79), superior to ROSE, OESIL and SFSR, and inferior to the CSRS.CONCLUSIONS: BNP, NT-proBNP, hs-cTnT, and hs-cTnI concentrations provide useful diagnostic and prognostic information in ED patients with syncope.CLINICAL TRIAL REGISTRATION: URL: https://clinicaltrials.gov Unique Identifier: NCT01548352.

U2 - 10.1161/CIRCULATIONAHA.118.038358

DO - 10.1161/CIRCULATIONAHA.118.038358

M3 - SCORING: Journal article

C2 - 30798615

JO - CIRCULATION

JF - CIRCULATION

SN - 0009-7322

ER -