Cor Vasa 2016, 58(3):e303-e309 | DOI: 10.1016/j.crvasa.2015.09.001

Diagnostic value of electrocardiographic (resting and 24-h Holter) monitoring in comparison with NT-proBNP in the differential diagnosis of patients with cardiogenic and neurogenic syncope

Piotr J. Stryjewski^a,*, Agnieszka Kuczaj^b, Ryszard Braczkowski^c, Jadwiga Nessler^d, Ewa Nowalany-Kozielska^b

^a Cardiology Department, Chrzanow City Hospital, Poland

^b 2nd Department of Cardiology, Zabrze, Medical University of Silesia, Katowice, Poland

^c Department of Public Health, School of Public Health, Silesian Medical University, Poland

^d Coronary Disease Department, Institute of Cardiology, Medical School of Jagiellonian University, John Paul II Hospital, Cracow, Poland

Background: Syncope is a cause of 1-6% of hospitalizations. Both European and American syncope guidelines recommend a 12-lead ECG as part of the evaluation of all patients with unexplained loss of consciousness.

Objectives: The aim of this study was the assessment of the significance of ECG, Holter ECG and the concentration of NT-proBNP that would be useful in the differentiation of patients with cardiac and reflex syncope.

Methods: We investigated 100 patients (56 men), aged 18-77 years with reflex or cardiac syncope over the last 3 years. The following factors were investigated: age, sex, systolic and diastolic blood pressure, the presence of cardiovascular disease. Moreover, we assessed basic resting ECG parameters and 24-hour Holter ECG parameters, and NT-proBNP concentration in the differential diagnosis of syncope.

Results: Patients with reflex syncope were younger compared to patients with cardiac syncope (44.4 ± 16.5 vs. 60.8 ± 12.6; p < 0.001). A pathologic resting 12-lead ECG was present more frequently in the group with a cardiogenic type of syncope - 12 (24%) vs. 8 (16%). 24-hour Holter ECG monitoring showed no statistically significant difference between minimal, mean and maximal heart rates in the analyzed groups. However, statistically significant differences were observed in the occurrence of ventricular and supraventricular arrhythmias between the investigated groups. Patients with cardiac syncope had significantly higher concentrations of NT-proBNP compared to patients with reflex syncope (448.7 ± 212.2 vs. 68.2 ± 64.1; p < 0.0001).

Conclusions: Elevated NT-proBNP concentration is present in patients with a cardiogenic mechanism of syncope, despite the fact that a resting ECG is inconclusive.

Keywords: 24-h Holter; Electrocardiography; NT-proBNP; Syncope

Received: April 3, 2015; Revised: August 26, 2015; Accepted: September 3, 2015; Published: June 1, 2016  Show citation