The role of amino n-terminal pro-brain natriuretic peptide (NT-PROBNP) in the diagnosis of cardiac or noncardiac syncope in children admitted to the emergency department

Aim: Cardiac syncope is a life-threatening condition in children. There are few studies on the role of natriuretic peptides in the detection of cardiac syncope in children. The aim of this study is to evaluate the diagnostic value and clinical significance of N-terminal pro-B type natriuretic peptide (NT-proBNP) concentrations in the differential diagnosis of pediatric cardiac and noncardiac syncope. Material and Methods: The study was carried out prospectively between 01 October 2018 and 01 November 2019 at Children's Hospital of Ege University Faculty of Medicine, Emergency Department. A total of 197 patients aged between 3 and 18 years presented to the emergency department with syncope (sudden and temporary loss of consciousness). During the study period 50 healthy children who examined and assesed at the outpatient clinic of general pediatrics in our hospital assigned as the control group. Patients' demographic characteristics (age, sex), past medical histories, their physical examination findings were recorded. Basic laboratory tests (complete blood count, blood electrolytes (sodium, potasium), blood glucose, liver function tests (AST, ALT), renal function tests (urea, creatinine) and cardiac markers (creatinine kinase-MB (CK-MB), troponin), telecardiography and electrocardiography (ECG) from patients with anamnesis, (syncope with exertion, chest pain, history of previous diseases, etc.), family history (sudden cardiac death in family, etc.), physical examination (abnormal heart sounds, neurological deficit, abnormal breathing sounds, etc.) were performed. All patients underwent echocardiography (ECO) and were evaluated by the pediatric cardiologist. Tilt test and 24-hour holter were applied to the pediatric cardiologist. NT-proBNP concentrations were determined in all syncope cases. Demographic characteristics and NT-proBNP concentrations of the control group were recorded. Our study was supported by Ege University Scientific Research Project (BAP) TTU-2019-20289. Results: In our study, syncope cases; 68.5% (135) were girls and 31.5% (62) were boys (female/male ratio was 2.9 / 1). The median age of syncope cases was 12.8 years (3-17 years). 50% (25) of the control group were female and 50% (25) were male. The median age of the control group was 10.6 (3-17 years) years. According to the etiology of syncope cases were examined, it was found that 8.6% (17) were of cardiac origin and 91.4% (180) were of noncardiac origin. Creatinine kinase-MB (CK-MB) values of 131 patients (66.5%) were evaluated. The mean CK-MB value was 4.5 µg / L (min-max: 0.8-14.2) in cardiac syncope group and 1.9 µg / L (min-max: 0.5-20.1) in non-cardiac syncope group. = 0.022). Troponin levels of 196 patients (99.5%) were evaluated and mean values were 49.2 µg / L (min-max: 13-519) in the cardiac group and 13 µg / L (min-max: 13-13) in the noncardiac group. (p = 0.000). The mean QTc distance was 0.42 seconds (min-max: 0.34-0.51) in cardiac syncope group and 0.39 seconds (min-max: 0.32-0.44) in noncardiac syncope group. There was a statistically significant difference between the two groups (p = 0.008). When the ECHO findings were evaluated, the rate of abnormal ECHO was 47% (n = 8) in cardiac syncope group consisting of 17 patients and 3.9% (n = 7) in noncardiac group (p = 0.000). In addition, abnormal Holter ECG findings were found in 5 patients (71.4%) in the cardiac group, whereas abnormal Holter ECG findings were found in 5 patients (15.6%) in the noncardiac group (p = 0.007). When plasma NT-proBNP results were examined in the patient group and control group; the mean NT-proBNP value of the control group was 49.5 ng / L; In the patient group, it was 437.4 ng / L for cardiac syncope and 44.5 ng / L for noncardiac syncope. When the NT-proBNP values in the syncope and control group children were compared, the NT-proBNP values in the cardiac-induced syncope group were significantly higher than those in the noncardiac and control groups (p=0.000, p=0.001, respectively). There was no significant difference between NT-proBNP values between noncardiac group and control group (p=1,000). Discussion: Our study showed that increased plasma NT-proBNP concentrations in patients admitted to the pediatric emergency department due to syncope are a useful biomarker for predicting cardiac origin of syncope and thus predicting prognosis.