REVIEW   Open

Italian Journal of Emergency Medicine 2020 April;9(1):35-40

DOI: 10.23736/S2532-1285.20.00003-8

Copyright © 2020 THE AUTHORS

This is an open access article under the CC BY-NC-ND license

language: English

Novel biomarkers in diagnosis and prognosis of syncope: a systematic review

Stefania LALLONI ¹, Marta LUBIAN ¹, Alessandro MANTUA ¹, Umberto MELIGA ¹ ✉, Davide CASTAGNO ², Emanuele PIVETTA ³

¹ School of Medicine, University of Turin, Turin, Italy; ² Division of Cardiology, Department of Medical Sciences, University of Turin, Turin, Italy; ³ Department of General and Specialty Medicine, Città della Salute e della Scienza, Turin, Italy

INTRODUCTION: Syncope is defined as a loss of consciousness, related to an insufficient blood flow to the brain. It could be caused by several conditions, mainly divided in cardiac and neurally mediated. However, even performing all the recommended tests, a wide percentage (20-40%) of syncopes is still classified as having an “unknown origin.” Some new biomarkers have been proposed to solve this uncertainty, and the aim of this review is to describe these biomarkers and the available relevant evidence.
EVIDENCE ACQUISITION: A systematic research on PubMed Library was conducted to identify all the relevant literature published in the last five years; studies were considered eligible if they investigated diagnosis or prognosis of cardiogenic, vasovagal (VV) or orthostatic hypotension (OH) syncope by using a biomarker in patients older than 39 years. The biomarkers considered were: heart-type fatty acid binding protein (H-FABP), N-terminal fragment of the precursor of brain natriuretic peptide (NT-proBNP), C-terminal endothelin-1 precursor fragment (CT-proET1), human midregional pro-atrial natriuretic peptide (MR-proANP), copeptin, renin, cathecolamines, as diagnostic indicators; matrix metalloproteinase 7 (MMP-7), thrombomodulin (TM), myoglobin, (MB), T-cell immunoglobulin and mucin domain 1 (TIM-1), NT-proBNP, high-sensitivity cardiac troponin T (hscTnT), as prognosis indicators.
EVIDENCE SYNTHESIS: To date, no studies have clearly defined either efficacy or effectiveness of new biomarkers to establish diagnosis and prognosis among patients with acute syncope.
CONCLUSIONS: There is no evidence of the usefulness of biomarker in the diagnosis and prognosis of syncope; further studies are needed.

KEY WORDS: Biomarkers; Syncope; Diagnosis; Prognosis