Diagnostic and Prognostic Value of High-sensitivity Cardiac Troponin T in Patients with Syncope - 23/01/15
, Felicitas Geier, MSc a, Steffen Popp, MD a, Katrin Singler, MD b, Alexander Smolarsky, MD c, Thomas Bertsch, MD d, Christian Müller, MD e, Yvonne Greve, MD aAbstract |
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.
Le texte complet de cet article est disponible en PDF.Keywords : Cardiac troponin, Emergency service, Healthcare, Hospital, Quality of Healthcare, Quality Indicators, Syncope
Plan
| Funding: None. |
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| Conflict of Interest: MC and TB have received financial support for clinical studies by Roche Diagnostics GmbH (Mannheim, Germany). CM has received research support from the European Union, the Swiss National Science Foundation, the Swiss Heart Foundation, the Cardiovascular Research Foundation Basel, Abbott, Alere, Brahms, Nanosphere, Roche, Siemens, and the Department of Internal Medicine, University Hospital Basel (Basel, Switzerland); and is a speaker for and receives consulting honoraria from Abbott, Alere, AstraZeneca, BG Medicine, bioMérieux Clinical Diagnostics, Brahms, Cardiorentis, Lilly, Novartis, Radiometer, Roche, and Siemens. |
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| Authorship: All authors had access to the data and played a role in writing this manuscript. |
Vol 128 - N° 2
P. 161 - février 2015 Retour au numéro
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