The diagnostic significance of NT-proBNP and troponin I in emergency department patients presenting with palpitations

Abstract

OBJECTIVE:This prospective study investigated the diagnostic significance of the N-terminal pro-brain natriuretic (NT-proBNP) and troponin I peptides in emergency department patients presenting with palpitations.METHODS:Two groups of patients with palpitations but without documented supraventricular tachycardia were compared: a group with supraventricular tachycardia (n = 49) and a control group (n = 47). Both groups were diagnosed using electrophysiological studies during the study period. Blood samples were obtained from all of the patients to determine the NT-proBNP and troponin I levels within the first hour following arrival in the emergency department.RESULT:The mean NT-proBNP levels were 207.74±197.11 in supraventricular tachyarrhythmia group and 39.99±32.83 pg/mL in control group (p<0.001). To predict supraventricular tachycardia, the optimum NT-proBNP threshold was 61.15 pg/mL, as defined by the receiver operating characteristic (ROC) curve, with a non-significant area under the ROC curve of 0.920 (95% CI, 0.86-0.97, p<0.001). The NT-proBNP cut-off for diagnosing supraventricular tachycardia had 81.6% sensitivity and 91.5% specificity. Supraventricular tachycardia was significantly more frequent in the patients with NT-proBNP levels ≥61.15 pg/mL (n = 44, 90.9%, p>0.001). The mean troponin I levels were 0.17±0.56 and 0.01±0.06 pg/mL for the patients with and without supraventricular tachycardia, respectively (p<0.05). Of the 96 patients, 21 (21.87%) had troponin I levels ≥0.01: 2 (4.25%) in the control group and 19 (38.77%) in the supraventricular tachycardia group (p<0.001).CONCLUSION:Troponin I and, in particular, NT-proBNP peptide were helpful for differentiating supraventricular tachycardia from non- supraventricular tachycardia palpitations. Further randomized, large, multicenter trials are needed to define the benefit and diagnostic role of NT-proBNP and troponin I in the management algorithm of patients presenting with palpitations in emergency departments.

Cardiovascular Biomarkers: Lessons of the Past and Prospects for the Future

“…Furthermore, BNP and NT-proBNP are related to arrhythmias as both are increased in atrial fibrillation patients [ 154 , 155 , 156 ]. Parallel rise in the circulating levels of NPs and troponins were also reported in patients with various tachycardias [ 157 ]. Evidence from animal experiments suggests that BNP mRNA and its protein increase as early as 10 min after transient lethal ventricular arrhythmias, possibly mediated by myocardial stretch [ 158 ].…”

Exercise-Induced Hyponatremia: An Assessment of the International Hydration Recommendations Followed During the Gran Trail De Peñalara and Vitoria-Gasteiz Ironman Competitions

“…In fact, Hew-Butler et al proposed that Pro-BNP participates as a counter-regulator of AVP secretion when the latter is stimulated by hypovolemia ( 55 ). Tachycardia-induced acute myocardial stress could also elevate Pro-BNP levels ( 56 , 57 ). Harris et al ( 58 ) have suggested that pro-BNP could be involved in the development of endurance-sport hyponatremia.…”

Abdominal Pain as an Initial Manifestation of Paroxysmal Supraventricular Tachycardia in Children

“…However, elevated level of troponin-I was not correlated with the presence of abdominal pain and rather, the researchers observed that high level of NT-proBNP was correlated with presence of abdominal pain. Although the mechanisms regulating myocardial production or release of NT-proBNP in the PSVT remain unclear, enough loading of ventricular and/or atrial stretch during PSVT may enhance the release of NT-proBNP (11,12). Magioncalda et al reported that the conversion to sinus rhythm in PSVT was achieved in a low percentage of patients with NT-proBNP levels > 4500 pg/mL, while the majority of those with levels < 1500 pg/mL were normalized, even by means of antiarrhythmic drugs alone (13).…”