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Péptidos natriuréticos de tipo B y troponinas cardíacas para el diagnóstico y la estratificación del riesgo de

Jeanne du Fay de Lavallaz^1,2, Patrick Badertscher^1,2,3, Thomas Nestelberger^1,2

¹Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (J.d.F.d.L., P.B., T.N., T.Z., J.W., R.T., C.P., D.W., J.B., L.K., I.S., J.L., E.M., M.K., T.R.).

|February 26, 2019

Resumen

Los biomarcadores como el BNP y la troponina ayudan a diagnosticar el síncope cardíaco y a predecir los eventos adversos en pacientes de emergencia. Estas pruebas mejoran las evaluaciones clínicas existentes para la evaluación del síncope.

Área de la Ciencia:

Cardiología
Investigación de biomarcadores
Medicina de emergencia

Sus antecedentes:

La utilidad diagnóstica y pronóstica del péptido natriurético de tipo B (BNP), el proBNP N-terminal (NT-proBNP) y la troponina cardíaca de alta sensibilidad (hs-cTn) en pacientes con síncope sigue sin estar clara.
El síncope es una presentación común en los departamentos de emergencia, que requiere herramientas precisas de diagnóstico y estratificación de riesgos.

Objetivo del estudio:

Evaluar la precisión diagnóstica y pronóstica de BNP, NT-proBNP, hs-cTnT y hs-cTnI en pacientes mayores de 45 años que presentan síncope.
Comparar la precisión de estos biomarcadores con las puntuaciones de evaluación clínica establecidas.

Principales métodos:

Estudio prospectivo de diagnóstico multicéntrico en el que participaron 1538 pacientes con síncope.
Medición ciega de las concentraciones de BNP, NT-proBNP, hs-cTnT y hs-cTnI.
Síncope cardíaco juzgado por los médicos; seguimiento de 1 año para eventos cardíacos adversos importantes (MACE).

Principales resultados:

Los biomarcadores fueron significativamente elevados en el síncope cardíaco (15,2% de los casos).
La precisión diagnóstica (AUC) para el síncope cardíaco fue de 0,77-0,78 para los biomarcadores individuales, superior a la de EGSYS (0,68). Los biomarcadores combinados mejoraron el AUC a 0,81.
La precisión de pronóstico (AUC) para MACE fue de 0,75-0,79, superando a ROSE, OESIL y SFSR, pero inferior a CSRS.

Conclusiones:

BNP, NT-proBNP, hs-cTnT y hs-cTnI proporcionan información valiosa de diagnóstico y pronóstico en pacientes con síncope en el departamento de emergencias.
Estos biomarcadores pueden ayudar a descartar el síncope cardíaco en aproximadamente el 30% de los pacientes.
Los hallazgos apoyan la integración de estos biomarcadores en los protocolos de manejo del síncope.

Palabras clave:

NT-proBNP (en inglés)péptido natriurético del cerebro servicio de urgencias, hospital Sincopio La troponina también

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