{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T20:32:26Z","timestamp":1785443546309,"version":"3.56.0"},"reference-count":55,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2017,12,2]]},"abstract":"\n Background<\/jats:title>\n \n The early detection of cardiac syncope is challenging. We aimed to evaluate the diagnostic value of 4 novel prohormones, quantifying different neurohumoral pathways, possibly involved in the pathophysiological features of cardiac syncope: midregional\u2013pro\u2010A\u2010type natriuretic peptide (\n MR<\/jats:styled-content>\n pro\n ANP<\/jats:styled-content>\n ), C\u2010terminal proendothelin 1, copeptin, and midregional\u2010proadrenomedullin.\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n We prospectively enrolled unselected patients presenting with syncope to the emergency department (\n ED<\/jats:styled-content>\n ) in a diagnostic multicenter study.\n ED<\/jats:styled-content>\n probability of cardiac syncope was quantified by the treating\n ED<\/jats:styled-content>\n physician using a visual analogue scale. Prohormones were measured in a blinded manner. Two independent cardiologists adjudicated the final diagnosis on the basis of all clinical information, including 1\u2010year follow\u2010up. Among 689 patients, cardiac syncope was the adjudicated final diagnosis in 125 (18%). Plasma concentrations of\n MR<\/jats:styled-content>\n pro\n ANP<\/jats:styled-content>\n , C\u2010terminal proendothelin 1, copeptin, and midregional\u2010proadrenomedullin were all significantly higher in patients with cardiac syncope compared with patients with other causes (\n P<\/jats:italic>\n <0.001). The diagnostic accuracies for cardiac syncope, as quantified by the area under the curve, were 0.80 (95% confidence interval [CI], 0.76\u20130.84), 0.69 (95%\n CI<\/jats:styled-content>\n , 0.64\u20130.74), 0.58 (95%\n CI<\/jats:styled-content>\n , 0.52\u20130.63), and 0.68 (95%\n CI<\/jats:styled-content>\n , 0.63\u20130.73), respectively. In conjunction with the\n ED<\/jats:styled-content>\n probability (0.86; 95%\n CI<\/jats:styled-content>\n , 0.82\u20130.90),\n MR<\/jats:styled-content>\n pro\n ANP,<\/jats:styled-content>\n but not the other prohormone, improved the area under the curve to 0.90 (95%\n CI,<\/jats:styled-content>\n 0.87\u20130.93), which was significantly higher than for the\n ED<\/jats:styled-content>\n probability alone (\n P<\/jats:italic>\n =0.003). An algorithm to rule out cardiac syncope combining an\n MR<\/jats:styled-content>\n pro\n ANP<\/jats:styled-content>\n level of <77\u00a0pmol\/L and an\n ED<\/jats:styled-content>\n probability of <20% had a sensitivity and a negative predictive value of 99%.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n The use of\n MR<\/jats:styled-content>\n pro\n ANP<\/jats:styled-content>\n significantly improves the early detection of cardiac syncope among unselected patients presenting to the\n ED<\/jats:styled-content>\n with syncope.\n <\/jats:p>\n <\/jats:sec>\n \n Clinical Trial Registration<\/jats:title>\n \n URL<\/jats:styled-content>\n :\n http:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n . Unique identifier:\n NCT<\/jats:styled-content>\n 01548352.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.117.006592","type":"journal-article","created":{"date-parts":[[2017,12,15]],"date-time":"2017-12-15T01:10:24Z","timestamp":1513300224000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":17,"title":["Prohormones in the Early Diagnosis of Cardiac Syncope"],"prefix":"10.1161","volume":"6","author":[{"given":"Patrick","family":"Badertscher","sequence":"first","affiliation":[{"name":"Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland"},{"name":"GREAT Network, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Nestelberger","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland"},{"name":"Department of Internal Medicine, University Hospital Basel University of Basel, Switzerland"},{"name":"GREAT Network, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeanne du Fay","family":"de Lavallaz","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel University of Basel, Switzerland"},{"name":"GREAT Network, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Than","sequence":"additional","affiliation":[{"name":"GREAT Network, Rome, Italy"},{"name":"Christchurch Hospital, Christchurch, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beata","family":"Morawiec","sequence":"additional","affiliation":[{"name":"GREAT Network, Rome, Italy"},{"name":"2nd Department of Cardiology, Medical University of Silesia, Zabrze, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damian","family":"Kawecki","sequence":"additional","affiliation":[{"name":"GREAT Network, Rome, Italy"},{"name":"2nd Department of Cardiology, Medical University of Silesia, Zabrze, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d2scar","family":"Mir\u00f3","sequence":"additional","affiliation":[{"name":"GREAT Network, Rome, Italy"},{"name":"Emergency Department, Hospital Clinic, Barcelona, Catalonia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatriz","family":"L\u00f3pez","sequence":"additional","affiliation":[{"name":"GREAT Network, Rome, Italy"},{"name":"Emergency Department, Hospital Clinic, Barcelona, Catalonia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F. 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