Diagnostic and prognostic value of cTnT high-sensitive in patients with syncope.
Am J Med. 2014 Oct 15;
Authors: Christ M, Geier F, Popp S, Singler K, Smolarsky A, Bertsch T, Müller C, Greve Y
PURPOSE: We examined the diagnostic and predictive value of cardiac troponin T high-sensitive (cTnThs) in syncope patients.
METHODS: Analysis of consecutive syncope patients presenting to the emergency department. The primary endpoint is the accuracy to diagnose a cardiac syncope. In addition, the study explores the prognostic relevance of cTnThs in patients with cardiac and non-cardiac syncope.
RESULTS: 360 patients were enrolled (median age: 70.5 years; male: 55.8%, 23.9% >80 years). Cardiac syncope was present in 22%, reflex syncope in 40%, syncope due to orthostatic hypotension in 20% and unexplained syncope in 17.5% of patients. 148 patients (41%) had cTnThs levels above the 99% confidence interval (cutoff point). The diagnostic accuracy for cTnThs levels to determine the diagnosis of cardiac syncope was quantified by the AUC (0.77, CI: 0.72 - 0.83; p<0.001). A comparable AUC (0.78, CI: 0.73-0.83; p<0.001) was obtained for the predictive value of cTnThs levels within 30 days: While patients with increased cTnThs levels had 52% likelihood for adverse events, patients with cTnThs levels below the cutoff point had a low risk (negative predictive value: 83.5%). Increased cTnThs levels indicate adverse prognosis in patients with non-cardiac causes of syncope, but not in patients with cardiac syncope being a risk factor for adverse outcome by itself.
CONCLUSIONS: Emergency department patients with syncope display a high proportion of life-threatening conditions. cTnThs levels display a limited diagnostic and predictive accuracy for the identification of syncope patients at high risk.
PMID: 25447619 [PubMed - as supplied by publisher]