Management of patients with syncope (loss of consciousness) is a serious problem concerning 1 - 2 per cent of Emergency Department presentations. Of these, it is known that between six and 20 per cent of patients will have a problem with their heart. The rapid and accurate identification of patients with cardiac related syncope is an important clinical need which until this time has not been met.
This observational study will evaluate the diagnostic value of patients’ history, clinical judgement and new blood tests (biomarkers) for cardiac syncope. The study will recruit 720 adult patients across multiple sites internationally. Eligibility will be aged based, for those 40 years and older, and presenting to the ED with syncope. The EMF grant was awarded to fund the Queensland portion that will recruit 60 adult patients of this larger international study that includes a two year follow up.
With regard to the biomarker: plasma concentrations of MRproANP, C-terminal proendothelin 1, copeptin, and midregional-proadrenomedullin were all significantly higher in patients with cardiac syncope compared with patients with other causes. This led the team to conclude that the use of MRproANP significantly improves the early detection of cardiac syncope among unselected patients.
When the clinicians looked at the prevalence of pulmonary embolism (PE) -- a blood clot in the heart -- as a cause of syncope, they only detected the condition in 19 out of 1,397 patients presenting with syncope to the ED, The incidence of new PEs or cardiovascular death during 2-year follow-up was 0.9%. In the subgroup of patients hospitalized (47%), PE was detected at presentation in 15 patients. The incidence of new PEs or cardiovascular death during 2-year follow-up was 0.9%. They concluded that PE seems to be an uncommon cause of syncope among patients presenting to the ED. Therefore, systematic PE-screening in all patients with syncope does not seem warranted.
-Badertscher P., de Lavallaz, J. du F., Hammerer-Lercher A., Nestelberger T., Zimmermann T., Geiger M., Imahorn O., Miró Ò., Salgado E., Christ M., Cullen L., Than M., Martin-Sanchez F. J., Di Somma S., Peacock W. F., Keller D.I., Costabel J.P., Walter ., Boeddinghaus J., Twerenbold R., Méndez A., Gospodinov B., Puelacher C., Wussler D., Koechlin L., Kawecki D., Geigy N., Strebel I., Lohrmann J., Kühne M., Reichlin T., Mueller C., for the BASEL IX Investigators "Prevalence of Pulmonary Embolism in Patients With Syncope",
'Journal of the American College of Cardiology', Aug 2019, 74 (6) 744-754. doi: 10.1016/j.jacc.2019.06.020
-Badertscher, P., Nestelberger, T., de Lavallaz, J. du F., et al, “Prohormones in the Early Diagnosis of Cardiac Syncope”, Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, 2017;6(12):e006592. doi.org/10.1161/JAHA.117.006592
-Badertscher, P. Nestelberger T., Du Fay De Lavallaz J., et al., “P469 Pro-hormones in the early diagnosis of cardiac syncope”, European Society for Cardiology Congress, August 2017, Spain
-Badertscher P., Nestelberger T., Du Fay De Lavallaz J., et al., “Natural history of syncope: insights from the BASEL IX study”, European Society for Cardiology Congress, August 2017, Spain.
-Du Fay De Lavallaz, J. et al., “24-hour patterning of different syncope etiologies in patients presenting to the emergency department”, European Society for Cardiology Congress, August 2017, Spain.
Prof Louise Cullen
Prof William Parsonage