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Brain natriuretic peptide and high-sensitivity Troponin at 3 hours post emergency department attendance with unexplained syncope predict 90 day outcome

Matthew James Reed, Hannah Brutin, Neil R. Grubb, Christopher C. Lang, Alasdair J. Gray, Kirsty Simpson, Allan MacRaild, Christopher J. Weir
  • Matthew James Reed http://orcid.org/0000-0003-1308-4824
    Emergency Medicine Research Group Edinburgh (EMERGE), Department of Emergency Medicine, Royal Infirmary of Edinburgh; Edinburgh Acute Care, Usher Institute of Population Health Sciences and Informatics, College of Medicine and Veterinary Medicine, University of Edinburgh, United Kingdom | matthew.reed@nhslothian.scot.nhs.uk
  • Hannah Brutin
    College of Medicine and Veterinary Medicine, University of Edinburgh, United Kingdom
  • Neil R. Grubb
    Department of Cardiology, Royal Infirmary of Edinburgh, United Kingdom
  • Christopher C. Lang
    Department of Cardiology, Royal Infirmary of Edinburgh, United Kingdom
  • Alasdair J. Gray
    Emergency Medicine Research Group Edinburgh (EMERGE), Department of Emergency Medicine, Royal Infirmary of Edinburgh; Edinburgh Acute Care, Usher Institute of Population Health Sciences and Informatics, College of Medicine and Veterinary Medicine, University of Edinburgh, United Kingdom
  • Kirsty Simpson
    Emergency Medicine Research Group Edinburgh (EMERGE), Department of Emergency Medicine, Royal Infirmary of Edinburgh, United Kingdom
  • Allan MacRaild
    Emergency Medicine Research Group Edinburgh (EMERGE), Department of Emergency Medicine, Royal Infirmary of Edinburgh, United Kingdom
  • Christopher J. Weir
    Edinburgh Clinical Trials Unit and Centre for Population Health Sciences, Usher Institute of Population Health Sciences and Informatics, Edinburgh, United Kingdom

Abstract

To investigate if Brain Natriuretic Peptide (BNP) and highsensitivity troponin I predict significant arrhythmia, symptomatic significant arrhythmia and 90-day death and/or Major Adverse Cardiac Event in Emergency Department (ED) unexplained syncope patients investigated with a 14-day ambulatory electrocardiogram (ECG) recorder. Single-centre, prospective, cohort study. Patients 16 years or over presenting within 6 hours of an episode of unexplained syncope were fitted with an ambulatory ECG recorder (Zio® XT monitor) and had high-sensitivity troponin I and BNP measured on ED admission and 3 hours later. Between 17/11/2015 and 13/06/2017, 86 patients were recruited. 24 had significant arrhythmia, 9 symptomatic significant arrhythmia and 26 patients had death and/or Major adverse cardiac events by 90 days. BNP at admission, three hours and change in BNP and high-sensitivity troponin I at three hours were associated with significant arrhythmia and serious outcome. BNP>20pg/mL and/or high-sensitivity troponin I above the 99% sex specific centile (M>34ng/L, F>16ng/L) at 3 hours had a sensitivity of 100% (21/21; 95% CI 81%-100%) and specificity of 43% (16/37; 28%-60%) for significant arrhythmia and a sensitivity of 100% (22/22; 95% CI 82%- 100%) and specificity of 44% (16/36; 28%-62%) for serious outcome both at 90 days. The combination of BNP and high-sensitivity troponin I at 3 hours shows promise as a potential predictive marker for serious arrhythmia and serious outcome at 90 days and deserves further exploration as a rule out test to enable safe discharge of patients from the ED who are at low risk of having cardiac syncope and subsequent adverse events.

Keywords

Ambulatory electrocardiography monitoring; Cardiac arrhythmias; Syncope; Diagnostic tests.

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Submitted: 2018-06-21 22:51:04
Published: 2018-08-09 14:22:32
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Copyright (c) 2018 Matthew James Reed, Hannah Brutin, Neil R. Grubb, Christopher C. Lang, Alasdair J. Gray, Kirsty Simpson, Allan MacRaild, Christopher J. Weir

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