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Response by du Fay de Lavallaz et al to Letter Regarding Article, “B-Type Natriuretic Peptides and Cardiac Troponins for Diagnosis and Risk-Stratification of Syncope”

2019; Lippincott Williams & Wilkins; Volume: 140; Issue: 17 Linguagem: Inglês

10.1161/circulationaha.119.042847

1524-4539

Jeanne du Fay de Lavallaz, Patrick Badertscher, Christian Müller,

Heart Rate Variability and Autonomic Control

HomeCirculationVol. 140, No. 17Response by du Fay de Lavallaz et al to Letter Regarding Article, "B-Type Natriuretic Peptides and Cardiac Troponins for Diagnosis and Risk-Stratification of Syncope" Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBResponse by du Fay de Lavallaz et al to Letter Regarding Article, "B-Type Natriuretic Peptides and Cardiac Troponins for Diagnosis and Risk-Stratification of Syncope" Jeanne du Fay de Lavallaz, MD, PhD, Patrick Badertscher, MD and Christian Müller, MD Jeanne du Fay de LavallazJeanne du Fay de Lavallaz Cardiovascular Research Institute Basel, Switzerland (J.d.F.d.L., P.B., C.M.). Rush University Hospital, Chicago, IL (J.d.F.d.L). , Patrick BadertscherPatrick Badertscher Cardiovascular Research Institute Basel, Switzerland (J.d.F.d.L., P.B., C.M.). Charleston Hospital, SC (P.B.). and Christian MüllerChristian Müller Cardiovascular Research Institute Basel, Switzerland (J.d.F.d.L., P.B., C.M.). University Hospital Basel, Switzerland (C.M.). Originally published21 Oct 2019https://doi.org/10.1161/CIRCULATIONAHA.119.042847Circulation. 2019;140:e731–e732In Response:We thank Dr Nguyen et al for their critical review of our manuscript "B-Type Natriuretic Peptides and Cardiac Troponins for Diagnosis and Risk-Stratification of Syncope."1As correctly highlighted by Nguyen et al, further biomarkers or prohormones such as copeptin, pro–endothelin-1, and proadrenomedullin were collected as originally planned during study design and have already been evaluated in a previous publication.2As noted by Nguyen et al, the etiologies underlying cardiac syncope are heterogenous, ranging from arrhythmias to structural and valvular heart disease. Structural heart diseases, such as myocardial infarction or valvular diseases, as well as tachyarrhythmias or pulmonary embolism, all lead to changes in intracardiac volumes and filling pressures. Numerous studies have shown that natriuretic peptides are reliable surrogates for these changes in hemodynamic stress, mediated by volume or pressure overload.3 As highlighted in our analysis, bradyarrhythmias seem to be less correlated to natriuretic peptide concentrations than tachyarrhythmias, but previous research suggested that loss of atrioventricular synchrony during the bradycardic event could lead to an increased wall tension, therefore increasing these biomarkers' circulating concentrations.4The establishment of an exact diagnosis in syncope patients is challenging and other studies tended to focus on prognostic endpoints. To the best of our knowledge, a single other study5 also focused on the diagnostic endpoint of cardiac syncope, which were defined by using the work-up available during the index event only. BASEL IX (Basel Syncope Evaluation Study) goes beyond the initial patient evaluation by incorporating all relevant cardiovascular findings and events detected during the first year of follow-up. Our stringent methodology moreover requires 2 fully trained physicians to agree on the exact syncope etiology, which further bolster the validity of our diagnostic evaluation. A systematic diagnostic work-up encompassing, for instance, an electrophysiologic study or a loop recorder implantation in all participants goes beyond the observational design of our study. We do, however, agree that further well-structured, possibly controlled, and randomized studies are required to definitively highlight the importance of biomarkers in the diagnostic evaluation of patients presenting with syncope.DisclosuresDr Mueller has received research support from the Swiss National Science Foundation, the Swiss Heart Foundation, the European Union, the Kommission für Technologie und Innovation, the Cardiovascular Research Foundation Basel, Abbott, AstraZeneca, Biomerieux, Beckman Coulter, BG medicine, Brahms, Critical Diagnostics, Radiometer, Roche, Siemens, and Singulex, as well as speaker/consulting honoraria or travel support from Abbott, Alere, Bayer, Bristol-Myers Squibb, Boehringer Ingelheim, Brahms, Cardiorentis, Daiichi Sankyo, Novartis, Roche, Sanofi, Siemens, and Singulex. Dr Badertscher has received research funding from the University of Basel, from Stiftung für Herzschrittmacher und Elektrophysiologie, and from Freiwillige Akademische Gesellschaft Basel outside of the submitted work. Dr du Fay de Lavallaz has nothing to disclose.Footnoteshttps://www.ahajournals.org/journal/circReferences1. du Fay de Lavallaz J, Badertscher P, Nestelberger T, Zimmermann T, Miró Ò, Salgado E, Christ M, Geigy N, Cullen L, Than M, et al. B-type natriuretic peptides and cardiac troponins for diagnosis and risk-stratification of syncope.Circulation2019; 139:2403–2418.LinkGoogle Scholar2. Badertscher P, Nestelberger T, du F de Lavallaz J, Than M, Morawiec B, Kawecki D, Miró Ò, López B, Martin-Sanchez FJ, Bustamante J, et al. Prohormones in the early diagnosis of cardiac syncope.J Am Heart Assoc2017; 6: e006592.LinkGoogle Scholar3. Mueller C, McDonald K, de Boer RA, Maisel A, Cleland JGF, Kozhuharov N, Coats AJS, Metra M, Mebazaa A, Ruschitzka F, et al; Heart Failure Association of the European Society of Cardiology. Heart Failure Association of the European Society of Cardiology practical guidance on the use of natriuretic peptide concentrations.Eur J Heart Fail. 2019; 21:715–731. doi: 10.1002/ejhf.1494CrossrefMedlineGoogle Scholar4. Kováts T, Tomcsányi J. Bradycardia and B-type natriuretic peptide.Int J Cardiol. 2009; 135:238–239. doi: 10.1016/j.ijcard.2008.03.086CrossrefMedlineGoogle Scholar5. Rosso A Del, Ungar A, Maggi R, Giada F, Petix NR, De Santo T, Menozzi C, Brignole M. Clinical predictors of cardiac syncope at initial evaluation in patients referred urgently to a general hospital: the EGSYS score.Heart2008; 94:1620–1626.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Clerico A, Zaninotto M, Aimo A, Musetti V, Perrone M, Padoan A, Dittadi R, Sandri M, Bernardini S, Sciacovelli L, Trenti T, Malloggi L, Moretti M, Burgio M, Manno M, Migliardi M, Fortunato A and Plebani M (2022) Evaluation of the cardiovascular risk in patients undergoing major non-cardiac surgery: role of cardiac-specific biomarkers, Clinical Chemistry and Laboratory Medicine (CCLM), 10.1515/cclm-2022-0481, 60:10, (1525-1542), Online publication date: 27-Sep-2022., Online publication date: 1-Sep-2022. Clerico A, Zaninotto M, Passino C, Aspromonte N, Piepoli M, Migliardi M, Perrone M, Fortunato A, Padoan A, Testa A, Dellarole F, Trenti T, Bernardini S, Sciacovelli L, Colivicchi F, Gabrielli D and Plebani M (2020) Evidence on clinical relevance of cardiovascular risk evaluation in the general population using cardio-specific biomarkers, Clinical Chemistry and Laboratory Medicine (CCLM), 10.1515/cclm-2020-0310, 59:1, (79-90), Online publication date: 26-Jan-2021., Online publication date: 1-Jan-2021. Cediel G, Codina P, Spitaleri G, Domingo M, Santiago-Vacas E, Lupón J and Bayes-Genis A (2021) Gender-Related Differences in Heart Failure Biomarkers, Frontiers in Cardiovascular Medicine, 10.3389/fcvm.2020.617705, 7 Cheng Y, Ou J, Tang B, Wang Q, Liang M, Wang Z and Wu Z (2020) N-Terminal Pro-B-Type Natriuretic Peptide in Tricuspid Valve Replacement, Seminars in Thoracic and Cardiovascular Surgery, 10.1053/j.semtcvs.2020.05.007, 32:4, (801-810), Online publication date: 1-Dec-2021. October 22, 2019Vol 140, Issue 17 Advertisement Article InformationMetrics © 2019 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.119.042847PMID: 31634015 Originally publishedOctober 21, 2019 PDF download Advertisement SubjectsRemodeling