natriuretic-peptide--brain and Syncope

This study aims to review pediatric pulmonary hypertension (PH) by comparing the guidelines of the European Society of Cardiology (ESC)/European Respiratory Society (ERS), the American Heart Association (AHA)/American Thoracic Society (ATS), and the European Pediatric Pulmonary Vascular Disease Network (EPPVDN). All three sets of guidelines define PH as having a mean pulmonary artery pressure of ≥25 mmHg and accept the validity of the World Health Organization (WHO) classification system. Every child with a high index of suspicion for PH should undergo an initial work-up of chest X-rays, electrocardiography, and echocardiography. The AHA/ATS guidelines emphasize the necessity of cardiac catheterization and hemodynamic studies. As mentioned in the AHA/ATS guidelines, the symptoms and tests that can detect PH include right ventricle failure, WHO functional class, syncope, echocardiography findings, hemodynamic data, brain natriuretic peptide (BNP)/N-terminal pro-BNP, the 6-min walk test, and cardiopulmonary exercise tests. The EPPVDN guidelines refer to positive acute vasoreactivity test results and growth as risk factors. All three guidelines highlight the importance of treating and following affected children in specialized centers and recommend calcium channel blockers as a first-line treatment in children (aged >12 months) who have a positive acute vasoreactivity test. Children with PH have distinct clinical features. In order to overcome the controversies related to the optimal management of pediatric PH, well-designed clinical studies should be carried out on a large cohort of affected children.

Topics: Calcium Channel Blockers; Cardiac Catheterization; Child; Echocardiography; Electrocardiography; Hemodynamics; Humans; Hypertension, Pulmonary; Natriuretic Peptide, Brain; Practice Guidelines as Topic; Predictive Value of Tests; Radiography, Thoracic; Randomized Controlled Trials as Topic; Syncope

The role of cardiac biomarkers in risk stratification of syncope is unclear. We undertook a systematic review to assess their predictive value for short-term major adverse cardiovascular events (MACE). We conducted a systematic review using MEDLINE, EMBASE, DARE and Cochrane databases from inception to July 2014. We included studies involving adult syncope patients that evaluated cardiac biomarker levels for risk stratification during acute management and excluded case reports, reviews and studies involving children. Primary outcome (MACE) included death, cardiopulmonary resuscitation, myocardial infarction (MI), structural heart disease, pulmonary embolism, significant hemorrhage or cardiac procedural interventions. Secondary outcome analysis assessed for prediction of MI, cardiac syncope and death. Two reviewers extracted patient-level data based on the cut-off reported. Pooled sensitivities and specificities were calculated using patient-level data. A total of 1862 articles were identified, and 11 studies with 4246 patients were included. Studies evaluated 3 biomarkers: contemporary troponin (2693 patients), natriuretic peptides (1353 patients) and high-sensitive troponin (819 patients). The pooled sensitivities and specificities for MACE were: contemporary troponin 0.29 (95 % CI 0.24, 0.34) and 0.88 (95 % CI 0.86, 0.89); natriuretic peptides 0.77 (95 % CI 0.69, 0.85) and 0.73 (95 % CI 0.70, 0.76); high-sensitive troponin 0.74 (95 % CI 0.65, 0.83) and 0.65 (95 % CI 0.62, 0.69), respectively. Natriuretic peptides and high-sensitive troponin showed good diagnostic characteristics for both primary and secondary outcomes. Natriuretic peptides and high-sensitive troponin might be useful in risk stratification.

Topics: Biomarkers; Cardiopulmonary Resuscitation; Humans; Myocardial Infarction; Natriuretic Peptide, Brain; Prognosis; Risk Assessment; Syncope; Troponin

Syncope is a common presenting complaint to the emergency department (ED). Its assessment is difficult. Some serious causes of syncope are transient and patients with a potentially life threatening condition may appear well by the time they reach the ED. Accurate history taking is vital and is often diagnostic whilst identification of a cardiac cause is associated with an increased mortality. This is related to underlying cardiac disease; patients presenting with syncope who have significant cardiac disease should be investigated thoroughly to determine the nature of the underlying heart disease and the cause of syncope. Early work suggested that as many as 30% of patients with cardiac syncope died within one year of presentation. This led to physicians admitting many patients with unexplained syncope however presently there is little evidence that focussed investigation, or even admission leads to an improved prognosis. Studies looking at syncope clinical decision units have though shown these to be of some benefit. Risk stratification studies on syncope in the ED have attempted to help emergency physicians target high-risk patients once those with clearly identifiable conditions have been identified and managed. These clinical decision rules have suffered from poor external validation and in the USA where many of these tools were developed, a universal consensus approach remains lacking. Although no individual tool has yet been successfully implemented into standard practice, as a whole they have probably enabled emergency physicians to become more aware of the risk factors that are likely to lead to poor outcome. It is likely that serious outcome in syncope although significant, is not quite as common as previously thought. Presently the American College of Emergency Physician (ACEP) guidelines are the most useful guidelines written for the emergency physician. With biochemical markers showing some promise, further work may lead to incorporation of these into existing clinical decision rules and guidelines to improve their sensitivity and specificity.

Topics: Biomarkers; Emergency Medicine; Emergency Service, Hospital; Guideline Adherence; Heart Diseases; Humans; Medical History Taking; Natriuretic Peptide, Brain; Physical Examination; Practice Guidelines as Topic; Syncope; Troponin I

This paper reviews the use of 3 biomarkers, BNP (brain natriuretic peptide), troponins and D-dimers, in 3 common clinical situations: the patient presenting with dyspnea, with chest pain or with syncope. The diagnostic utility and the pronostic implications of a positive as well as a negative test are reviewed according the most recent medical literature. Interpretation of false positive and false negative results is also discussed. Familiarity with the use of these tests is increasingly important because practicioners will be soon provided with rapid bed-side multi-markers assays to help them in their differential diagnosis while examining the patient.

Topics: Angina Pectoris; Biomarkers; Diagnosis, Differential; Dyspnea; Fibrin Fibrinogen Degradation Products; Humans; Natriuretic Peptide, Brain; Syncope; Troponin

The evidence about the use of natriuretic peptides (NP) to predict mortality in the pre-hospital setting is limited. The main objective of this study is to assess the ability of point-of-care testing (POCT) N-terminal portion of B-type natriuretic peptide (NT-proBNP) to predict 2-day in-hospital mortality of acute cardiovascular diseases (ACVD).. We conducted a multicentric, prospective, observational study in adults with ACVD transferred by ambulance to emergency departments (ED). The primary outcome was 2-day in-hospital mortality. The discrimination capacity of the NT-proBNP was performed through a prediction model trained using a derivation cohort and evaluated by the area under the curve (AUC) of the receiver operating characteristic on a validation cohort.. A total of 1006 patients were recruited. The median age was 75 (IQR 63-84) years and 421 (41.85%) were females. The 2-day in-hospital mortality was 5.8% (58 cases). The predictive validity of NT-proBNP, for 2-day mortality reached the following AUC: 0.823 (95%CI: 0.758-0.889, p < 0.001), and the optimal specificity and sensitivity were 73.1 and 82.7. Predictive power of NT-proBNP obtained an AUC 0.549 (95%CI: 0.432-0.865, p 0.215) for acute heart failure, AUC 0.893 (95%CI: 0.617-0.97, p < 0.001) for ischemic heart disease, AUC 0.714 (95%CI: 0.55-0.87, p = 0.0069) for arrhythmia and AUC 0.927 (95%CI: 0.877-0.978, p < 0,001) for syncope.. POCT NT-proBNP has proven to be a strong predictor of early mortality in ACVD, showing an excellent predictive capacity in cases of syncope. However, this biomarker does not appear to be useful for predicting outcome in patients with acute heart failure.

Topics: Acute Disease; Adult; Aged; Biomarkers; Cardiovascular Diseases; Emergency Service, Hospital; Female; Heart Failure; Humans; Male; Natriuretic Peptide, Brain; Peptide Fragments; Point-of-Care Systems; Prognosis; Prospective Studies; Syncope

The diagnosis of cardiac syncope remains a challenge in the emergency department (ED).. Assessing the diagnostic accuracy of the early standardized clinical judgement (ESCJ) including a standardized syncope-specific case report form (CRF) in comparison with a recommended multivariable diagnostic score.. In a prospective international observational multicentre study, diagnostic accuracy for cardiac syncope of ESCJ by the ED physician amongst patients ≥ 40 years presenting with syncope to the ED was directly compared with that of the Evaluation of Guidelines in Syncope Study (EGSYS) diagnostic score. Cardiac syncope was centrally adjudicated independently of the ESCJ or conducted workup by two ED specialists based on all information available up to 1-year follow-up. Secondary aims included direct comparison with high-sensitivity cardiac troponin I (hs-cTnI) and B-type natriuretic peptide (BNP) concentrations and a Lasso regression to identify variables contributing most to ESCJ.. Cardiac syncope was adjudicated in 252/1494 patients (15.2%). The diagnostic accuracy of ESCJ for cardiac syncope as quantified by the area under the curve (AUC) was 0.87 (95% CI: 0.84-0.89), and higher compared with the EGSYS diagnostic score (0.73 (95% CI: 0.70-0.76)), hs-cTnI (0.77 (95% CI: 0.73-0.80)) and BNP (0.77 (95% CI: 0.74-0.80)), all P < 0.001. Both biomarkers (alone or in combination) on top of the ESCJ significantly improved diagnostic accuracy.. ESCJ including a standardized syncope-specific CRF has very high diagnostic accuracy and outperforms the EGSYS score, hs-cTnI and BNP.

Topics: Biomarkers; Clinical Reasoning; Early Diagnosis; Emergency Service, Hospital; Humans; Natriuretic Peptide, Brain; Prospective Studies; Syncope; Troponin I

Studies have reported that natriuretic peptides provide prognostic information for emergency department (ED) syncope.. To evaluate whether adding. Prospective cohort study.. 6 EDs in 2 Canadian provinces.. 1452 adult ED patients with syncope.. Serum NT-proBNP was measured locally at 1 site and batch processed at a central laboratory from other sites. The concentrations were not available to treating physicians or for adjudication of outcomes.. An adjudicated composite outcome of 30-day SAEs, including death and cardiac (arrhythmic and nonarrhythmic) and noncardiac events.. Of 1452 patients enrolled, 152 (10.5% [95% CI, 9.0% to 12.1%]) had 30-day SAEs, 57 (3.9%) of which were identified after the index ED disposition. Serum NT-proBNP concentrations were significantly higher among patients with SAEs than those without them (median, 626.5 ng/L vs. 81 ng/L;. Our study was powered to detect a 3% difference in the area under the curve. The heterogeneity of outcomes and robust baseline discrimination by the CSRS will make improvements challenging.. Although serum NT-proBNP concentrations were generally much higher among ED patients with syncope who had a 30-day SAE, this blood test added little new information to the CSRS. Routine use of NT-proBNP for ED syncope prognostication is not recommended.. Physicians' Services Incorporated Foundation, Canadian Institutes of Health Research, and The Ottawa Hospital Academic Medical Organization.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biomarkers; Canada; Emergency Service, Hospital; Female; Follow-Up Studies; Humans; Incidence; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Prospective Studies; Protein Precursors; Risk Assessment; Risk Factors; Syncope; Young Adult

Topics: Humans; Natriuretic Peptide, Brain; Syncope; Troponin

Topics: Humans; Natriuretic Peptide, Brain; Syncope; Troponin

An estimated 1.2 million annual emergency department (ED) visits for syncope/near syncope occur in the United States. Cardiac biomarkers are frequently obtained during the ED evaluation, but the prognostic value of index high-sensitivity troponin (hscTnT) and natriuretic peptide (NT-proBNP) are unclear. The objective of this study was to determine if hscTnT and NT-proBNP drawn in the ED are independently associated with 30-day death/serious cardiac outcomes in adult patients presenting with syncope.. A prespecified secondary analysis of a prospective, observational trial enrolling participants ≥ age 60 presenting with syncope, at 11 United States hospitals, was conducted between April 2013 and September 2016. Exclusions included seizure, stroke, transient ischemic attack, trauma, intoxication, hypoglycemia, persistent confusion, mechanical/electrical invention, prior enrollment, or predicted poor follow-up. Within 3 hours of consent, hscTnT and NT-proBNP were collected and later analyzed centrally using Roche Elecsys Gen 5 STAT and 2010 Cobas, respectively. Primary outcome was combined 30-day all-cause mortality and serious cardiac events. Adjusting for illness severity, using multivariate logistic regression analysis, variations between primary outcome and biomarkers were estimated, adjusting absolute risk associated with ranges of biomarkers using Bayesian Markov Chain Monte Carlo methods.. The cohort included 3,392 patients; 367 (10.8%) experienced the primary outcome. Adjusted absolute risk for the primary outcome increased with hscTnT and NT-proBNP levels. HscTnT levels ≤ 5 ng/L were associated with a 4% (95% confidence interval [CI] = 3%-5%) outcome risk, and hscTnT > 50 ng/L, a 29% (95% CI = 26%-33%) risk. NT-proBNP levels ≤ 125 ng/L were associated with a 4% (95% CI = 4%-5%) risk, and NT-proBNP > 2,000 ng/L a 29% (95% CI = 25%-32%) risk. Likelihood ratios and predictive values demonstrated similar results. Sensitivity analyses excluding ED index serious outcomes demonstrated similar findings.. hscTnT and NT-proBNP are independent predictors of 30-day death and serious outcomes in older ED patients presenting with syncope.

Topics: Adult; Aged; Biomarkers; Case-Control Studies; Emergency Service, Hospital; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prospective Studies; Syncope; Troponin T

Topics: Biomarkers; Emergency Service, Hospital; Humans; Natriuretic Peptide, Brain; Syncope; Troponin

We aimed to compare current syncope risk stratification scores and propose a new more feasible and easy-to-use one.. In this prospective cohort study, we enrolled all patients (≥18 years) with chief complaint of syncope if they were not eligible for admission in terms of high-risk features. San Francisco Syncope Rule, Osservatorio Epidemiologico sulla Sincope nel Lazio, and risk stratification of syncope in the emergency department scores were compared in our population.. Overall, 356 patients (mean age: 44.5 years, 46.3% male) were followed for 3 months. Serious adverse events occurred in 26 (7.3%) patients including 4 deaths. Odds ratio for adverse events was 6.8 [95% confidence interval (CI), 2.8-16.1; P < 0.001; area under the curve (AUC): 66.3], 7.7 (95% CI, 3.2-18; P < 0.001; AUC: 72.8), and 18 (95% CI, 7.1-45.4; P < 0.001; AUC: 70.8) when considering San Francisco Syncope Rule, Osservatorio Epidemiologico sulla Sincope nel Lazio, and risk stratification of syncope in the emergency department scores as the predicting tools, respectively. We proposed a relatively more feasible risk score (presenting symptoms, history of cardiovascular diseases, ejection fraction <50%, and predefined electrocardiography abnormalities). According to this syncope score, odds ratio for occurring adverse events was 20.9 (95% CI, 8.4-52; P < 0.001; AUC: 79.8).. The 3 syncope risk scores could somehow predict 3-month adverse events. We found more feasible indicators that could predict serious events better. It suits well for emergency department.

Topics: Adult; Area Under Curve; Cardiac Surgical Procedures; Cardiovascular Diseases; Cohort Studies; Defibrillators, Implantable; Electrocardiography; Emergency Service, Hospital; Feasibility Studies; Female; Follow-Up Studies; Humans; Hypoxia; Incidence; Intracranial Hemorrhages; Male; Middle Aged; Mortality; Myocardial Infarction; Natriuretic Peptide, Brain; Odds Ratio; Oximetry; Pacemaker, Artificial; Peptide Fragments; Prognosis; Prospective Studies; Prosthesis Implantation; Risk Assessment; Stroke; Stroke Volume; Subarachnoid Hemorrhage; Syncope

B-type natriuretic peptides (BNPs) have been investigated as biomarkers for risk stratification of patients with syncope. Their concentration can be influenced by age and co-morbidities. In the present study, we compared the change in N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels within 6 hours in patients with vasovagal and arrhythmic syncope to determine whether this change can predict arrhythmic syncope. Using a case-control design, 33 patients were enrolled. Of the 33 patients, 18 with arrhythmic syncope, as they underwent controlled ventricular tachycardia or ventricular fibrillation (VF) during device safety testing of an implantable cardioverter defibrillator implantation or battery replacement, were compared with 15 patients, who during a tilt-table test were diagnosed with vasovagal syncope (VS). For each patient, a blood sample for NT-proBNP evaluation was collected at baseline and 6 hours after the episode of ventricular tachycardia, VF, or VS. We calculated the percentage of increase in the 6-hour NT-proBNP concentration between the 2 groups using nonparametric techniques. We also calculated the area under a receiver operating characteristic curve with the 95% confidence intervals. The 6-hour change in the NT-proBNP concentrations between patients who had had an episode of ventricular tachycardia or VF and patients with VS was significantly different, with a median increase of 32% in the ventricular tachycardia or VF group versus 5% in the VS group (p <0.01). The area under a receiver operating characteristic curve to predict arrhythmic syncope was 0.8 (95% confidence interval 0.65 to 0.95). In conclusion, the results of the present study suggest that a 6-hour NT-proBNP increase might be able to predict arrhythmic syncope. Future work is needed to confirm these findings in undifferentiated emergency department patients who present with syncope.

Topics: Aged; Biomarkers; Defibrillators, Implantable; Disease Progression; Electrocardiography; Female; Follow-Up Studies; Humans; Male; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Protein Precursors; ROC Curve; Severity of Illness Index; Syncope; Tachycardia, Ventricular

Natriuretic peptides have an increasing role in assessing cardiovascular conditions. The number of papers addressing their role in the evaluation of children with syncope of unclear etiology is sparse. The aim of this study was to determine whether measuring atrial natriuretic peptide (ANP) and the inactive form, N-terminal prohormone of brain natriuretic peptide (NT-proBNP) concentration in children admitted due to differential diagnosis of syncope can be helpful in establishing the most probable cause of this condition.. The study included 88 patients between 9 and 18 years of age hospitalized due to syncope. The control group comprised 25 healthy children. In order to identify the cause of syncope, children with this condition were subjected to cardiologic and neurologic evaluation, and ANP and NT-proBNP concentrations were determined.. The syncope group and the controls did not differ significantly in terms of natriuretic peptides concentrations. Similarly, no significant intergroup differences in natriuretic peptide concentrations were documented between children representing various types of response to the tilt test, and between the subgroups of patients with syncope of various origins.. Analysis of natriuretic peptides concentrations in children with syncope does not result in unambiguous findings that would enable establishing accurate diagnosis.

Topics: Adolescent; Atrial Natriuretic Factor; Cardiovascular Diseases; Case-Control Studies; Child; Echocardiography; Electrocardiography; Electroencephalography; Female; Humans; Male; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Syncope

The aim of this study was to assess the clinical significance of N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations in the differentiation of patients with cardiac and reflex syncope.. The study included a group of 100 patients (56 women, 44 men), aged 18-77 years (mean 52.6 ± 16.7), with a history of reflex (group I) or cardiac syncope (group II). Diagnosis of syncope was performed according to the European Society of Cardiology (ESC) guidelines. In all patients, the concentration of NT-proBNP was measured.. The assessment of NT-proBNP concentrations showed significantly higher concentrations in group II than in group I (448.7 ± 212.2 vs. 68.2 ± 64.1 pg/ml, P<0.0001). The receiver operating characteristic (ROC) curve analysis revealed that the concentration of NT-proBNP at 210.5 pg/ml may be a useful cut-off point which allows the prediction of cardiac syncope with 98 % specificity, 94 % sensitivity, and 94 % negative predictive value. In patients with cardiac arrhythmias and conduction abnormalities, the concentrations of NT-proBNP were higher in comparison to those without such disorders.. The concentration of NT-proBNP is useful in the diagnosis of syncope and may initially guide the diagnostic process. The NT-proBNP value exceeding 200 pg/ml seems to be the most rational in determining cardiac syncope.

Topics: Adolescent; Adult; Aged; Anthropometry; Biomarkers; Diagnosis, Differential; Electrocardiography; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prospective Studies; Reflex; Syncope; Syncope, Vasovagal

Syncope is a transient loss of consciousness, which is the result of global brain hypoperfusion, characterized by rapid onset, short duration, and spontaneous complete resolution. Syncope is a common clinical problem due to its complex, multi-causal etiology, not completely understood pathogenesis and potential complications. Diagnosis of syncope is often associated with the implementation of many medical tests. In the recent years, the role of determining the concentration of NT-proBNP in the differential diagnosis of syncope has been highlighted. Aims of the study was analysis of NT-proBNP concentrations in patients with cardiogenic syncope in comparison to patients with neurogenic syncope and determination of the threshold value of NT-proBNP to differentiate cardiac and neurogenic syncope and to determine its sensitivity and specificity. The study included 160 pts (64 man, 96 women), aged 18 - 77 yrs (mean age 50,6) with a reflex syncope (group I) or cardiac syncope (group II). To determine the etiology of syncope, collected were: medical history for symptoms and circumstances of the syncope, measurements of blood pressure, resting ECG recording, cardiac echocardiography, and the concentration of NT-proBNP levels. Results: the group I included 80 pts (29 men, 51 women), aged 18 - 72 yrs (mean age 41.2). Group II included 80 pts (35 man, 45 women), aged 38 - 77 yrs (mean age 62.1). The assessment of concentrations of NT-proBNP showed significantly higher levels in group II than group I (467.6 +/- 227.4 vs 64.1 +/- 59.1; p <0.0001). In patients with arrhythmias and conduction abnormalities, the levels of NT-proBNP were higher in comparison to those without such disorders (364 +/- 249 vs. 171 +/- 209 pg/ml, p < 0.001). It was found that the concentration of NT-proBNP at 230.6 pg/ml might be a cut-off point that allows the prediction of cardiogenic cause of syncope with 96% specificity, 92% sensitivity and 93% negative predictive value. Conclusions: 1. The concentration of peptide NT-proBNP patients with reflex syncope. 2. It was shown that the cut off concentration of the NT-proBNP equal 230.6 pg/ml is characterized by the high sensitivity, specificity, and negative predictive value in determining the etiology of syncope.

Topics: Adolescent; Adult; Aged; Diagnosis, Differential; Echocardiography; Electrocardiography; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Sensitivity and Specificity; Syncope; Syncope, Vasovagal; Young Adult

This study was designed to evaluate the diagnostic value of B-type natriuretic peptide (BNP) in syncope in children and adolescents.. Serum BNP concentration was measured by electrochemiluminescence assay in 62 consecutive children and adolescents hospitalized for syncope.. Of the 62 children and adolescents hospitalized for syncope, 39 had noncardiac syncope, of whom 37 (59.7%) had autonomic-mediated reflex syncope and two (3.2%) had syncope of unknown cause. Twenty-three patients (37.1%) had cardiac syncope: 11 of these had cardiac arrhythmias and 12 had structural cardiac/cardiopulmonary disease. Patients with cardiac syncope had significantly higher serum BNP than those with non-cardiac syncope (958.78 ± 2443.41 pg/mL vs 31.05 ± 22.64 pg/mL, p < 0.05). Logistic multivariate regression analysis revealed that urinary incontinence during syncopal episodes, ECG abnormalities and increased serum BNP levels were independent predictors of cardiac syncope. At a cut-off value of 40.65 pg/mL, serum BNP was associated with significant risk of a cardiac cause of syncope, with sensitivity of 73.9% and specificity of 70.0% for distinguishing cardiac syncope from noncardiac syncope.. Serum BNP was helpful in differentiating cardiac syncope from noncardiac syncope in children and adolescents.

Topics: Adolescent; Biomarkers; Child; Female; Heart Diseases; Humans; Logistic Models; Male; Natriuretic Peptide, Brain; Syncope

Single clinical parameters are inaccurate for diagnostic and prognostic estimation in patients with syncope. The cardiac marker NT-pro-BNP has not thoroughly been evaluated for this application.. NT-pro-BNP was assessed in 161 consecutive patients (median age 69 years, 58% male) hospitalized for syncope in a cardiological university department and association (odds ratio: OR, 95% confidence interval: CI) with diagnosis of cardiac cause and 6-months outcome was analyzed.. NT-pro-BNP levels were significantly higher in patients with cardiac (n=78) compared to non-cardiac syncope (n=83). At a cutoff of 156 pg/ml, NT-pro-BNP showed a sensitivity of 89.7%, a specificity of 51.8% and a negative predictive value of 84.3% for the diagnosis of cardiac syncope. Increasing NT-pro-BNP was a significant predictor of cardiac syncope (OR 3.7, 95% CI 2.3-5.8 per standard deviation of Log NT-pro-BNP, p<0.001) and addition of NT-pro-BNP significantly improved a predictive model including heart rate, history of structural heart disease and abnormal ECG. Adding left-ventricular ejection fraction to the model did not change results. Sixty-three patients had an adverse event during hospitalization or 6-months follow-up. NT-pro-BNP>156 pg/ml significantly predicted an adverse outcome (OR 2.7, 95% CI 1.04-6.9, p=0.04) after multivariate adjustment.. In patients hospitalized for syncope, NT-pro-BNP was a strong and independent diagnostic and prognostic marker and addition to conventional criteria of history and examination improved the discriminatory performance. Randomized trials must clarify the benefit and position of NT-pro-BNP in the management algorithm of patients with syncope.

Topics: Aged; Algorithms; Arrhythmias, Cardiac; Biomarkers; Female; Heart Diseases; Hospitalization; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prognosis; Sensitivity and Specificity; Syncope

Topics: Female; Humans; Male; Natriuretic Peptide, Brain; Syncope; Ventricular Fibrillation

Topics: Female; Humans; Male; Natriuretic Peptide, Brain; Syncope; Ventricular Fibrillation

Brain natriuretic peptide (BNP) may be a good prognostic marker in syncope. The aim of this study was to establish whether there is any change in BNP in association with an acute presentation.. Patients aged ≥60 years admitted following presentation to the emergency department (ED) with syncope were eligible for prospective enrolment. Serial BNP measurements were performed on admission and at intervals up to 4 weeks after presentation.. Between 8 March 2010 and 14 April 2010, 31 patients were recruited and were suitable for analysis, including seven patients who returned to the ED at 4 weeks. Mean BNP rose from a baseline of 167.8 ng/ml to a peak of 303.2 ng/ml at 48 h and then returned to baseline at 4 weeks. BNP ratio reached 2.3 (more than twice admission level) at 18 h and peaked at 2.4 at 1 week before returning to baseline at 4 weeks.. BNP seems to rise from baseline to a peak between 18 h and 1 week after an acute syncopal episode in many patients. The reasons for this are not clear.

Topics: Aged; Aged, 80 and over; Biomarkers; Cohort Studies; Emergency Service, Hospital; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Predictive Value of Tests; Prospective Studies; Syncope

Topics: Aged; Aged, 80 and over; Biomarkers; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Syncope; Time Factors; Ventricular Fibrillation

NT-pro-BNP has been proposed as a good predictor of syncope adverse outcome in the Emergency Department (ED) [Pfister R, Diedrichs H, Larbig R, Erdmann E, Schneider CA. NT-pro-BNP for differential diagnosis in patients with syncope. Int J Cardiol 2008 Jan 29]. We hereby summarize four critical points that should be taken into account when seeking to identify a cardiac cause of syncope or dealing with a risk stratification approach of the patient in the ED. The first issue is that patients admitted to the hospital after syncope are usually sicker than those discharged because of a higher rate of co-morbidity. Secondly, the focus on discharged patients is of paramount importance to assess the goodness of a predictor. Aging, which affects NT-pro-BNP levels, is a limiting factor in interpreting results. Finally, in order to add valuable information to the clinical practice, we suggest to compare results obtained by NT-pro-BNP values and the most used prognostic risk scores, such as the OESIL and SFSR.

Topics: Aged; Biomarkers; Coronary Angiography; Diagnosis, Differential; Echocardiography; Electrocardiography, Ambulatory; Electrophysiologic Techniques, Cardiac; Emergency Service, Hospital; Exercise Test; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Syncope; Telemetry

Pulmonary arterial hypertension (PAH) is a rare complication of glycogen storage disease (GSD), and several cases with a poor outcome have been reported. A 17-year-old boy, who was diagnosed with GSD at 1 year of age, complained of shortness of breath on exertion, and was diagnosed with PAH based on the echocardiographic findings. Beraprost sodium (BPS) was started, and his symptoms improved after 3 months of treatment. Eighteen months later, he experienced frequent episodes of syncope. Because increasing the dose of BPS was ineffective, he was admitted to hospital. The echocardiogram showed marked elevation of the right ventricular pressure and low cardiac output, and his symptoms deteriorated despite continuous infusion of olprinone hydrochloride. Because a single dose of sildenafil increased his cardiac output, treatment with 25 mg sildenafil twice daily was started. His symptoms gradually ameliorated, and 3 weeks later he left the hospital. Two months after starting sildenafil, the cardiac index and the serous B-type natriuretic peptide concentration had become normal. Sildenafil may be effective in patients with secondary PAH and in patients who have developed tolerance to BPS.

Topics: Administration, Oral; Adolescent; Antihypertensive Agents; Drug Tolerance; Echocardiography; Electrocardiography; Epoprostenol; Glycogen Storage Disease Type I; Hemodynamics; Humans; Hypertension, Pulmonary; Male; Natriuretic Peptide, Brain; Piperazines; Purines; Severity of Illness Index; Sildenafil Citrate; Sulfones; Syncope; Treatment Outcome; Vasodilator Agents

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.. NT-pro-BNP was assessed in 61 patients admitted for syncope to our cardiological department of the University hospital Cologne, Germany.. 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.. 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.

Topics: Aged; Biomarkers; Coronary Angiography; Diagnosis, Differential; Echocardiography; Electrocardiography, Ambulatory; Electrophysiologic Techniques, Cardiac; Emergency Service, Hospital; Exercise Test; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Pilot Projects; Predictive Value of Tests; ROC Curve; Sensitivity and Specificity; Statistics, Nonparametric; Syncope; Telemetry

Markers for epileptic seizures are rare and their use has not been established in the evaluation of seizures and febrile convulsions (FC). Brain-type natriuretic peptide (BNP) is a natriuretic, diuretic, and vasodilator compound first discovered in the hypothalamus but mainly synthesized in the myocardium. The aim of this study was to assess whether epileptic seizures or FC are related to increased secretion of the N-terminal fragment of BNP (NT-proBNP).. Sixty-five postictal children (43 boys, 22 girls) and 31 children with epilepsy (20 boys, 11 girls) after a seizure-free period for at least 2 months serving as controls were enrolled. Postictal NT-proBNP levels were analyzed and controlled 24-48 h thereafter.. Plasma concentration of NT-proBNP was significantly higher 4 h postictal compared to 24-48 h postictal (p < 0.001). Subgroup analysis revealed increased NT-proBNP levels in children with tonic-clonic seizures and FC compared to children with partial motor seizures (p < 0.001), syncope (SYN; p < 0.01), or control population (p < 0.001).. Our results suggest that elevated plasma NT-proBNP levels are not specific for cardiac dysfunction. Postictal measurement of plasma NT-proBNP seems to be useful in discriminating different types of epilepsy, FC, and SYN in childhood.

Topics: Biomarkers; Child; Child, Preschool; Diagnosis, Differential; Epilepsy; Female; Heart Diseases; Humans; Male; Natriuretic Peptide, Brain; Peptide Fragments; Seizures, Febrile; Syncope

To assess the value of a near-patient brain natriuretic peptide (BNP) test to predict medium term (3 month) serious outcome for adult syncope patients presenting to a UK emergency department (ED).. This was a prospective cohort pilot study. Consecutive patients aged > or = 16 years presenting with syncope over a 3 month period were eligible for prospective enrolment. All patients who were medium or high risk according to our ED's existing syncope guidelines underwent near-patient BNP testing using the Triage point of care machine.. 99 patients were recruited. 72 of 82 high and medium risk patients underwent BNP measurement. 11 patients had a serious outcome, 9 of whom had BNP measured. In 25 (35%) patients, BNP was > or = 100 pg/ml, and in 3 of these it was > 1000 pg/ml. 6 of the 25 patients (24%) with a BNP > 100 pg/ml, and all 3 patients with a BNP > 1000 pg/ml, were in the serious outcome group. BNP was raised over 100 pg/ml in 6 of the 9 serious outcome patients having a BNP measured (66%), and over 1000 pg/ml in 3 (33%).. This early work suggests that BNP may have a role in the risk assessment of syncope patients in the ED. Further work is required to see how BNP interacts with other clinical variables. Near-patient BNP testing may be shown to be an independent predictor of adverse outcome either alone or incorporated into existing syncope clinical decision rules and scores in order to improve their sensitivity and specificity. Further studies are required to evaluate this.

Topics: Adult; Aged; Aged, 80 and over; Cause of Death; Chi-Square Distribution; Coronary Angiography; Electrocardiography; Female; Humans; Likelihood Functions; Male; Middle Aged; Natriuretic Peptide, Brain; Pilot Projects; Prospective Studies; Risk Assessment; Statistics, Nonparametric; Syncope

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.

Topics: Aged; Algorithms; Arrhythmias, Cardiac; Echocardiography; Electrocardiography; Electrocardiography, Ambulatory; Feasibility Studies; Female; Heart Diseases; Humans; Male; Natriuretic Peptide, Brain; Retrospective Studies; Sensitivity and Specificity; Syncope; Syncope, Vasovagal; Tilt-Table Test

The onset of symptoms is a critical point in the natural history of aortic stenosis and the cardinal indication for valve replacement. This study assessed the associations between natriuretic peptide levels, disease severity, and cardiac symptoms in aortic stenosis.. Seventy-four patients with isolated aortic stenosis underwent independent assessment of symptoms, transthoracic echocardiography, and measurement of plasma levels of atrial natriuretic peptide, brain natriuretic peptide (BNP), and N-BNP. Natriuretic peptide levels were also measured in 100 clinically normal control subjects. The aortic valve area was smaller in symptomatic patients (n=45) than in asymptomatic patients (n=29; mean, 0.71+/-0.23 cm2 and 0.99+/-0.31 cm2, respectively; P<0.0001). Plasma natriuretic peptide levels were higher in symptomatic patients than in asymptomatic patients (for N-BNP: median, 112 versus 33 pmol/L; interquartile range, 70 to 193 versus 16 to 58 pmol/L, respectively; P=0.0002). After adjustment for age, sex, serum creatinine, aortic valve area, and left ventricular ejection fraction, N-BNP levels were 1.74 times higher (95% confidence interval, 1.12 to 2.69) for symptomatic than asymptomatic patients with aortic stenosis (P=0.014). Natriuretic peptide levels increased with the New York Heart Association class (for N-BNP median values were 13, 34, 105, and 202 pmol/L for normal control subjects, class I, class II, and class III/IV patients, respectively; interquartile ranges for the same patients were 8 to 21, 16 to 58, 57 to 159, and 87 to 394 pmol/L; P<0.0001). Similar associations were observed for BNP and atrial natriuretic peptide.. Plasma natriuretic peptide levels are elevated in symptomatic patients with aortic stenosis. Measurement of natriuretic peptides may complement clinical and echocardiographic evaluation of patients with aortic stenosis.

Topics: Age Factors; Angina Pectoris; Aortic Valve Stenosis; Atrial Natriuretic Factor; Echocardiography; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Nerve Tissue Proteins; Peptide Fragments; ROC Curve; Sensitivity and Specificity; Sex Factors; Syncope