[Diagnostic value of high-sensitivity troponin I to predict cardiac causes after syncope/near syncope in emergency
1Service d'accueil des urgences, GHT Nord-Ardennes, centre hospitalier de Charleville-Mézières, 45, avenue de Manchester, 08000 Charleville-Mézières Ardennes, France; UFR de médecine de Reims, université de Reims Champagne-Ardenne, 51, rue Cognacq-Jay, CS30018, 51095 Reims cedex, France.
Insights
High-sensitivity troponin I (hs-cTnI) is not a reliable predictor of cardiac origin after syncope. Elevated hs-cTnI may indicate ventricular remodeling in heart failure.
Area of Science:
- Cardiology
- Emergency Medicine
- Biomarkers
Background:
- Syncope is a common presentation in emergency departments, often requiring differentiation between cardiac and non-cardiac causes.
- High-sensitivity troponin I (hs-cTnI) is a sensitive biomarker for myocardial injury, but its utility in diagnosing cardiac syncope is debated.
Purpose of the Study:
- To evaluate the diagnostic accuracy of hs-cTnI in predicting cardiac origin in patients presenting with syncope.
- To identify causes of elevated troponin levels in this patient cohort.
Main Methods:
- A study of 163 hospitalized patients diagnosed with syncope or near-syncope in the emergency department.
- Diagnostic accuracy of hs-cTnI was assessed and compared against the 2018 European Society of Cardiology (ESC) guidelines for high-risk syncope.
Main Results:
- Only 26% of patients had a cardiac origin for syncope.
- hs-cTnI showed low sensitivity (31%) and a positive predictive value (35%) for cardiac origin, performing worse than ESC risk stratification.
- Elevated hs-cTnI was associated with a fivefold increase in cardiac failure during hospitalization.
Conclusions:
- A positive hs-cTnI result in syncope patients is not predictive of cardiac origin.
- Elevated hs-cTnI may serve as an early indicator of ventricular remodeling in heart failure.
Aims:
The objective of this study is to evaluate the diagnostic accuracy of high-sensitivity (hs) troponin I to predict cardiac origin after syncope. The secondary objective is to determine the causes of elevated troponin.
Procedure:
Were included hospitalized patients with syncope/near syncope diagnosed in ED. The diagnostic accuracy to predict cardiac origin was evaluated and compared to the "high risk" group, defined by the 2018 European Society of Cardiology guidelines.
Results:
A total of 163 patients were enrolled, 26% had a cardiac origin. Positive troponin I hs predict a cardiac origin with a sensitivity of 31%, a specificity of 80%, positive predictive value of 35% and negative value of 77%. These diagnostic performances are not discriminating and lower than the ESC classification. A positive troponine I hs level is associated with 5 times more cardiac failure during the hospitalization.
Conclusion:
A positive troponin I hs level after syncope/near syncope is not predictive of cardiac origin. It appears to be an early marker of ventricular remodeling in heart failure.
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