NT-pro-BNP for diagnostic and prognostic evaluation in patients hospitalized for syncope
NT-pro-BNP for diagnostic and prognostic evaluation in patients hospitalized for syncope
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DOI：
10.1016/j.ijcard.2010.10.013
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发表时间：
2012-03-08
影响因子：
3.5
通讯作者：
Schneider, Christian A.
中科院分区：
文献类型：
--
作者：
Pfister, Roman;Hagemeister, Jens;Schneider, Christian A.
背景：单一的临床参数对晕厥患者的诊断和预后评估是不准确的。心脏标志物NT-pro-BNP的应用尚未得到充分的评价。方法：在161例连续患者中评估NT-pro-BNP（中位年龄69岁，58%男性）因晕厥在心脏病大学部门和协会住院（比值比：OR，95%可信区间：CI）与心脏原因诊断和6个月结果进行分析。与非心源性晕厥患者（n =83）相比，心源性晕厥患者（n=78）的NT-pro-BNP水平显著较高。以156 pg/ml为临界值，NT-pro-BNP诊断心源性晕厥的敏感性为89.7%，特异性为51.8%，阴性预测值为84.3%。NT-pro-BNP升高是心源性晕厥的重要预测因子（OR 3.7，95% CI 2.3-5.8，根据Log NT-pro-BNP的标准差，p 156 pg/ml显著预测多变量调整后的不良结局（OR 2.7，95% CI 1.04-6.9，p=0.04）。在因晕厥住院的患者中，NT-pro-BNP是一种强有力的独立诊断和预后标志物，除了传统的病史和检查标准外，还提高了区分能力。随机试验必须阐明NT-pro-BNP在晕厥患者管理算法中的获益和地位。(C)2010爱思唯尔爱尔兰有限公司版权所有。
Background: 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.Methods: 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.Results: 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 156pg/ml significantly predicted an adverse outcome (OR 2.7, 95% CI 1.04-6.9, p=0.04) after multivariate adjustment.Conclusions: 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. (C) 2010 Elsevier Ireland Ltd. All rights reserved.