B‐Type Natriuretic Peptide in Cardiogenic Syncope

1Drexel University College of Medicine, Philadelphia, PA
2Abington Memorial Hospital, Abington, PA
3Drexel University College of Medicine, Philadelphia, PA
4Drexel University College of Medicine, Philadelphia, PA
5Drexel University College of Medicine, Philadelphia, PA
6Abington Memorial Hospital, Abington, PA
7Abington Memorial Hospital, Abington, PA
8Drexel University College of Medicine, Philadelphia, PA

Meeting: Hospital Medicine 2008, April 3-5, San Diego, Calif.

Abstract number: 33

Background:

Syncope may be a harbinger of sudden death. Untreated patients with cardiogenic syncope can have a 6‐month mortality rate exceeding 10%. An accurate and cost‐effective test that focuses on risk stratification is required for initial triaging of patients with syncope. Brain‐type natriuretic peptide (BNP) is a natriuretic, diuretic, and vasodilator compound mainly synthesized in the myocardium. The aim of this study was to determine the utility of BNP as a marker for cardiogenic syncope.

Methods:

Adult patients (men, 116; median age, 81 years; range, 25‐99 years) admitted to our hospital with syncope (n = 205) and presyncope (n = 15) who also had an admission BNP assay performed were identified by 2 reviewers. Diagnosis was established retrospectively in 220 such consecutive patients using the ACC guidelines by reviewing medical records. BNP levels were determined using a chemiluminescence immunoassay with the Centaur XP kit (Siemens, Germany).

Results:

A specific cause of syncope was identified in 144 of the 220 patients (65%), including 58 patients (26%) with cardiac causes, 41 (19%) with reflex‐mediated causes, and 45 (20%) with orthostatic causes. Cause of syncope could not be identified in 76 patients (35%). BNP levels in the cardiac syncope group (median 432 pg/mL; range 12‐6160 pg/mL) were significantly higher than those in the other 3 groups (median 73 pg/mL; range 3‐2412 pg/mL; P < .0001). No significant differences were observed among the reflex‐mediated (37.5 pg/mL), orthostatic (98 pg/mL), and unknown groups (109 pg/mL). At a cutoff of 100 pg/mL, the sensitivity and specificity for BNP in identifying cardiogenic syncope were 81% and 57%, respectively, with positive and negative predictive values of 40% and 89%, respectively

Conclusions:

These results indicate a high sensitivity of BNP in identifying patients with cardiogenic syncope. In patients in whom the cause remained unknown, BNP levels were slightly elevated, suggesting that perhaps some patients with cardiogenic syncope were missed in this group. Prospective studies with BNP measurements in larger cohorts are needed to confirm the utility of BNP in syncope.

Author Disclosure:

A. Jan, none; B. Ghauri, none; H. Mahboob, none; B. Mujtaba, none; C. Nkonde, none; O. Fasan, none; A. Ramna chandran, none; F. Jan, none.

To cite this abstract:

Jan A, Mahboob H, Mujtaba B, Nkonde C, Fasan O, Ghauri B, Ramnachandran A, Jan F. B‐Type Natriuretic Peptide in Cardiogenic Syncope. Abstract published at Hospital Medicine 2008, April 3-5, San Diego, Calif. Abstract 33. Journal of Hospital Medicine. 2008; 3 (suppl 1). https://www.shmabstracts.com/abstract/btype-natriuretic-peptide-in-cardiogenic-syncope/. Accessed September 22, 2019.

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