Michael Christ1, Felicitas Geier2, Steffen Popp2, Katrin Singler3, Alexander Smolarsky4, Thomas Bertsch5, Christian Müller6, Yvonne Greve2. 1. Department of Emergency and Intensive Care Medicine, Paracelsus Medical University, Nuremberg, Germany. Electronic address: michael.christ@klinikum-nuernberg.de. 2. Department of Emergency and Intensive Care Medicine, Paracelsus Medical University, Nuremberg, Germany. 3. Institute for Biomedicine of Aging, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany. 4. Center of Trauma and Orthopaedic Surgery, Helios Vogtland-Klinikum Plauen, Plauen, Germany. 5. Department of Clinical Chemistry and Laboratory Medicine, Paracelsus Medical University, Nuremberg, Germany. 6. Department of Cardiology, University Hospital Basel, Basel, Switzerland.
Abstract
OBJECTIVE: We examined the diagnostic and predictive value of high-sensitivity cardiac troponin T (cTnThs) in patients with syncope. METHODS: We performed an analysis of consecutive patients with syncope presenting to the emergency department. The primary end point was the accuracy to diagnose a cardiac syncope. In addition, the study explored the prognostic relevance of cTnThs in patients with cardiac and noncardiac syncope. RESULTS: A total of 360 patients were enrolled (median age, 70.5 years; male, 55.8%; 23.9% aged >80 years). Cardiac syncope was present in 22% of patients, reflex syncope was present in 40% of patients, syncope due to orthostatic hypotension was present in 20% of patients, and unexplained syncope was present in 17.5% of patients. A total of 148 patients (41%) had cTnThs levels above the 99% confidence interval (CI) (cutoff point). The diagnostic accuracy for cTnThs levels to determine the diagnosis of cardiac syncope was quantified by the area under the curve (0.77; CI, 0.72-0.83; P < .001). A comparable area under the curve (0.78; CI, 0.73-0.83; P < .001) was obtained for the predictive value of cTnThs levels within 30 days: Patients with increased cTnThs levels had a 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 noncardiac causes of syncope, but not in patients with cardiac syncope being a risk factor for adverse outcome by itself. CONCLUSIONS: Patients with syncope presenting to the emergency department have a high proportion of life-threatening conditions. cTnThs levels show a limited diagnostic and predictive accuracy for the identification of patients with syncope at high risk.
OBJECTIVE: We examined the diagnostic and predictive value of high-sensitivity cardiac troponin T (cTnThs) in patients with syncope. METHODS: We performed an analysis of consecutive patients with syncope presenting to the emergency department. The primary end point was the accuracy to diagnose a cardiac syncope. In addition, the study explored the prognostic relevance of cTnThs in patients with cardiac and noncardiac syncope. RESULTS: A total of 360 patients were enrolled (median age, 70.5 years; male, 55.8%; 23.9% aged >80 years). Cardiac syncope was present in 22% of patients, reflex syncope was present in 40% of patients, syncope due to orthostatic hypotension was present in 20% of patients, and unexplained syncope was present in 17.5% of patients. A total of 148 patients (41%) had cTnThs levels above the 99% confidence interval (CI) (cutoff point). The diagnostic accuracy for cTnThs levels to determine the diagnosis of cardiac syncope was quantified by the area under the curve (0.77; CI, 0.72-0.83; P < .001). A comparable area under the curve (0.78; CI, 0.73-0.83; P < .001) was obtained for the predictive value of cTnThs levels within 30 days: Patients with increased cTnThs levels had a 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 noncardiac causes of syncope, but not in patients with cardiac syncope being a risk factor for adverse outcome by itself. CONCLUSIONS:Patients with syncope presenting to the emergency department have a high proportion of life-threatening conditions. cTnThs levels show a limited diagnostic and predictive accuracy for the identification of patients with syncope at high risk.
Authors: Venkatesh Thiruganasambandamoorthy; Rosa Ramaekers; Mohammed Omair Rahman; Ian Gilmour Stiell; Lindsey Sikora; Sarah-Louise Kelly; Michael Christ; Pierre-Geraud Claret; Matthew James Reed Journal: Intern Emerg Med Date: 2015-10-23 Impact factor: 3.397
Authors: Shiraz Amin; Vedant Gupta; Gaixin Du; Colleen McMullen; Matthew Sirrine; Mark V Williams; Susan S Smyth; Romil Chadha; Seth Stearley; Jing Li Journal: J Med Internet Res Date: 2021-11-16 Impact factor: 5.428