Novel cardiovascular biomarkers in unexplained syncopal attacks: the SYSTEMA cohort
A Fedorowski1, P Burri, J Struck
1Department of Clinical Sciences, Lund University, Clinical Research Center, Malmö, Sweden. artur.fedorowski@med.lu.se
Journal of Internal Medicine
|March 21, 2013
Summary
Novel cardiovascular biomarkers, midregional pro-atrial natriuretic peptide (MR-proANP) and C-terminal endothelin-1 precursor fragment (CT-proET-1), show significant changes in common syncope types. These findings suggest new neurohormonal mechanisms in syncopal attacks.
Area of Science:
- Cardiology
- Nephrology
- Endocrinology
Background:
- Syncope is a common clinical problem with significant morbidity.
- Identifying the underlying cause of syncope is crucial for appropriate management.
- Novel biomarkers may offer new insights into the pathophysiology of syncope.
Purpose of the Study:
- To investigate resting levels of novel cardiovascular biomarkers in patients with common noncardiac syncope.
- To explore associations between specific syncope diagnoses and biomarker levels.
- To identify potential neurohormonal mechanisms involved in syncopal episodes.
Main Methods:
- Observational study of 255 patients with unexplained syncope.
- Expanded head-up tilt test with carotid sinus massage and nitroglycerin provocation.
- Logistic regression analysis of resting biomarker levels (CT-proAVP, CT-proET-1, MR-proANP, MR-proADM) and syncope diagnoses.
Main Results:
- Vasovagal syncope (VVS) probability associated with MR-proANP and CT-proET-1.
- Orthostatic hypotension (OH) probability associated with CT-proET-1.
- Carotid sinus hypersensitivity (CSH) associated with MR-proANP in older adults.
- Cardioinhibitory reflex strongly associated with low CT-proET-1.
- CT-proET-1 levels differentiated between VVS, OH, and cardioinhibitory reflex.
Conclusions:
- Resting levels of MR-proANP and CT-proET-1 are significantly altered in common syncope forms.
- These findings suggest novel neurohormonal mechanisms underlying syncopal attacks.
- Biomarkers like MR-proANP and CT-proET-1 may aid in syncope diagnosis and understanding.
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