Novel cardiovascular biomarkers in unexplained syncopal attacks: the SYSTEMA cohort
| Autor: | Olle Melander, Artur Fedorowski, Philippe Burri, Steen Juul-Möller, J. Struck |
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| Rok vydání: | 2013 |
| Předmět: |
Adult
Male medicine.hormone medicine.medical_specialty Adolescent Vasopressins Cardiovascular biomarkers 030204 cardiovascular system & hematology Syncope Endothelins Adrenomedullin Electrocardiography Young Adult 03 medical and health sciences 0302 clinical medicine Atrial natriuretic peptide Internal medicine Internal Medicine medicine Humans cardiovascular diseases 030212 general & internal medicine Aged Retrospective Studies Aged 80 and over Endothelin-1 biology business.industry Carotid sinus Syncope (genus) Middle Aged biology.organism_classification Peptide Fragments 3. Good health medicine.anatomical_structure Cohort cardiovascular system Cardiology Female business Atrial Natriuretic Factor Biomarkers |
| Zdroj: | Journal of Internal Medicine |
| ISSN: | 0954-6820 |
| Popis: | The aim of the study was to investigate the resting levels of novel cardiovascular biomarkers in common types of noncardiac syncope.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-proAVP), C-terminal endothelin-1 precursor fragment (CT-proET-1), midregional fragments of pro-atrial natriuretic peptide (MR-proANP) and pro-adrenomedullin (MR-proADM).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-proANP [Q1 vs. Q4: odds ratio (OR) 5.57, 95% confidence interval (CI) 1.86-16.74; P0.001] and CT-proET-1 (OR 7.17, 95% CI 2.43-21.13; P0.001). By contrast, the probability of OH was highest in the fourth quartile of CT-proET-1 (Q4 vs. Q1: OR 8.66, 95% CI 2.49-30.17; P0.001). Furthermore, CSH was most frequently observed in the first quartile of MR-proANP (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-proET-1 levels (Q1 vs. Q4: OR 69.7, 95% CI 6.97-696.6; P0.001). Moreover, in patients with VVS, a high concentration of CT-proET-1 was predictive of OH (OR per 1 SD 2.4, 95% CI 1.15-5.02; P = 0.02), whereas low CT-proET-1 suggested involvement of the cardioinhibitory reflex (OR per 1SD 0.42, 95% CI 0.25-0.70; P = 0.001).The levels of MR-proANP and CT-proET-1 are markedly changed in common forms of syncope, suggesting the involvement of novel neurohormonal mechanisms in syncopal attacks. |
| Databáze: | OpenAIRE |
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