The Role of Amino N-Terminal Pro-Brain Natriuretic Peptide (NTproBNP) in the Diagnosis of Cardiac or Noncardiac Syncope in Children Admitted to the Emergency Department

Project no. 20289 · Status: Kapanmış · 2019

Summary

Objective: Cardiac-induced syncope is a life-threatening condition in children, and the number of studies on the role of natriuretic peptides in its detection is very few. The aim of this study was to evaluate the diagnostic value and clinical significance of N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations in the differential diagnosis of patients with cardiac and noncardiac syncope.Methods: Children aged 3-18 years, who applied to the Pediatric Emergency Department of Ege University Medical Faculty Hospital between 01 October 2018 and 01 November 2019, due to syncope (sudden and temporary loss of consciousness) were included in our prospective study. Fifty healthy children aged between 3-18 years, who applied to the General Pediatrics outpatient clinic of Ege University Medical Faculty Hospital, were selected as the control group. Demographic characteristics (age, gender), anamnesis (whether there is a chronic disease, medications used), vital signs at the time of admission, and physical examination findings were recorded. All the patients included in the study were evaluated by the pediatric emergency specialist and pediatric health and diseases assistant. Basic laboratory tests (from the patients who are considered suitable) in line with the anamnesis (syncope with exertion, chest pain, history of previous diseases, etc.), family history (sudden cardiac death in the family, etc.), physical examination characteristics (abnormal heart sounds, neurological deficit, abnormal respiratory sounds, etc.) complete blood count, blood electrolytes (sodium, potassium), blood glucose, liver function tests (AST, ALT), kidney function tests (urea, creatinine)) and cardiac markers (creatinine kinase-MB (CK-MB), troponin), Telecardiography and electrocardiography (ECG) examinations were performed. Electroencephalography (EEG) was performed for neurological evaluation in all syncope patients. Echocardiography (ECO) was performed on all patients and evaluated by a pediatric cardiologist. Tilt test and 24-hour holter were applied to the patients deemed appropriate by the pediatric cardiologist. NT-proBNP concentrations were determined in all syncope cases. Demographic characteristics and NT-proBNP concentrations of the subjects included in the control group were recorded. Our study was supported by Ege University Scientific Research Project (BAP) TTU-2019-20289 number.Results: A total of 197 patients presented to the emergency department with syncope during the study period. Of the syncope cases included in our study, 68.5% (135) were female, 31.5% (62) were male (Girl/Male ratio: 2.9/1). The median age of syncope cases was 12.8 (3-17) years. A total of 50 patients (F/M) evaluated in the general pediatric outpatient clinic in the same period were selected as the control group. 50% (25) of the control group were girls and 50% (25) were boys. The median age of the control group was 10.6 (3-17 years) years. Considering their etiology, it was found that 8.6% (17) had cardiac origin and 91.4% (180) noncardiac origin syncope. The creatinine kinase-MB (CK-MB) values of a total of 131 subjects (66.5%) were measured. The mean CK-MB value was 4.5 µg/L (min-max: 0.8-14.2) in the cardiac syncope group, and 1.9 µg/L (min-max: 0.5-20) in the noncardiac origin syncope group. ,1) (p=0.022). The troponin values of 196 subjects (99.5%) of the syncope cases were checked and it was found to be 49.2 µg/L (min-max: 13-519) in the cardiac group and 13 µg/L (min-max: 13-13) in the noncardiac group. resulted (p=0.000). The mean QTc interval was 0.42 seconds (min-max: 0.34-0.51) in the cardiac syncope group, and 0.39 seconds (min-max: 0.32-0.44) in the noncardiac origin syncope group. There was a statistically significant difference between the two groups (p=0.008). When evaluated in terms of ECHO findings, the abnormal ECO rate was 47% (n=8) in the cardiac syncope group consisting of a total of 17 patients, while this rate was 3.9% (n=7) in the noncardiac group (p=0.000). In addition, 5 individuals (71.4%) in the cardiac group had abnormal Holter ECG findings, while 5 individuals (15.6%) in the noncardiac group had abnormal Holter ECG findings (p=0.007). When the plasma NT-proBNP results in the patient group and control group were examined; while the mean NT-proBNP value of the control group was 49.5 ng/L; In the patient group, it was found to be 437.4 ng/L in patients with syncope of cardiac origin and 44.5 ng/L in patients with syncope of noncardiac origin. When NT-proBNP values in children in the syncope and control groups were compared, NT-proBNP values in the cardiac origin syncope group were found to be statistically significantly higher than those in the noncardiac and control groups.Conclusion: Our study showed that increased plasma NT-proBNP concentrations in patients admitted to the pediatric emergency department due to syncope are a useful biomarker in predicting cardiac origin of syncope and therefore predicting prognosis.

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