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Novel cardiovascular biomarkers in unexplained syncopal attacks: the SYSTEMA cohort
Author(s) -
Fedorowski A.,
Burri P.,
Struck J.,
JuulMöller S.,
Melander O.
Publication year - 2013
Publication title -
journal of internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.625
H-Index - 160
eISSN - 1365-2796
pISSN - 0954-6820
DOI - 10.1111/joim.12043
Subject(s) - medicine , cardiology , confidence interval , copeptin , odds ratio , provocation test , quartile , vasopressin , anesthesia , endocrinology , pathology , alternative medicine
Objectives The aim of the study was to investigate the resting levels of novel cardiovascular biomarkers in common types of noncardiac syncope. Design and setting An observational study was conducted including 255 patients (mean age 60 years, range 15–93; 45% men) with unexplained syncopal attacks. Subjects underwent an expanded head‐up tilt test including carotid sinus massage, and nitroglycerin provocation if indicated. Using logistic regression, we explored the associations between specific diagnoses of syncope and resting levels of circulating biomarkers: C‐terminal pro‐arginine vasopressin ( CT ‐pro AVP ), C‐terminal endothelin‐1 precursor fragment ( CT ‐pro ET ‐1), midregional fragments of pro‐atrial natriuretic peptide ( MR ‐pro ANP ) and pro‐adrenomedullin ( MR ‐pro ADM ). Results A total of 142 (56%) patients were diagnosed with vasovagal syncope ( VVS ), 85 (33%) with orthostatic hypotension ( OH ) and 47 (18%) with carotid sinus hypersensitivity ( CSH ); in addition, 74 (29%) patients had more than one diagnosis. Thirty‐five patients (14%) demonstrated a cardioinhibitory reflex. The probability of VVS was highest in the first quartile of MR ‐pro ANP [Q1 vs. Q4: odds ratio ( OR ) 5.57, 95% confidence interval ( CI ) 1.86–16.74; P < 0.001] and CT ‐pro ET ‐1 ( OR 7.17, 95% CI 2.43–21.13; P < 0.001). By contrast, the probability of OH was highest in the fourth quartile of CT ‐pro ET ‐1 (Q4 vs. Q1: OR 8.66, 95% CI 2.49–30.17; P < 0.001). Furthermore, CSH was most frequently observed in the first quartile of MR ‐pro ANP (Q1 vs. Q4: OR 6.57, 95% CI 1.62–26.62; P = 0.008) among those over 60 years of age, whereas the cardioinhibitory reflex was strongly associated with low CT ‐pro ET ‐1 levels (Q1 vs. Q4: OR 69.7, 95% CI 6.97–696.6; P < 0.001). Moreover, in patients with VVS , a high concentration of CT ‐pro ET ‐1 was predictive of OH ( OR per 1 SD 2.4, 95% CI 1.15–5.02; P = 0.02), whereas low CT ‐pro ET ‐1 suggested involvement of the cardioinhibitory reflex ( OR per 1 SD 0.42, 95% CI 0.25–0.70; P = 0.001). Conclusions The levels of MR ‐pro ANP and CT ‐pro ET ‐1 are markedly changed in common forms of syncope, suggesting the involvement of novel neurohormonal mechanisms in syncopal attacks.