NT-pro-BNP for diagnostic and prognostic evaluation in patients hospitalized for syncope

Abstract 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 69years, 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 156pg/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.