Correlation of Cardiac Markers with Cardiac Syncope in Adult Patients Presenting in Emergency Department
Year: 2025
Type: article
Study design: Observational Study
Abstract: Cardiac syncope is associated with potentially serious cardiovascular conditions and requires early differentiation from non-cardiac causes. Cardiac biomarkers may provide additional diagnostic information when interpreted alongside clinical assessment and electrocardiographic findings. Objective: To determine the correlation and diagnostic performance of cardiac biomarkers for identifying cardiac syncope among adult patients presenting to the emergency department. Methods: This prospective analytical cross-sectional study was conducted in the Emergency Department of a Shifa international hospital from July 2025 to December 2025. A total of 80 consecutive adult patients presenting with syncope were included. Clinical characteristics, electrocardiographic findings, high-sensitivity cardiac troponin I (hs-cTnI), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and creatine kinase-MB (CK-MB) were assessed. Patients were classified as having cardiac or non-cardiac syncope based on comprehensive clinical evaluation. Biomarker associations were assessed using Spearman correlation, receiver operating characteristic analysis, and multivariable logistic regression. Results: Of the 80 patients, 28 (35.0%) had cardiac syncope and 52 (65.0%) had non-cardiac syncope. Patients with cardiac syncope had significantly higher median hs-cTnI [38 (16–94) vs. 8 (4–17) ng/L], NT-proBNP[620 (280–1420) vs. 128 (62–310) pg/mL], and CK-MB [4.9 (2.8–7.6) vs. 2.3 (1.5–4.0) ng/mL]. NT-proBNP showed the strongest correlation with cardiac syncope (ρ=0.56), followed by hs-cTnI (ρ=0.49) and CK-MB (ρ=0.32). NT-proBNP demonstrated the highest individual diagnostic discrimination (AUC=0.84), followed by hs-cTnI (AUC=0.79) and CK-MB (AUC=0.68). Combining hs-cTnI and NT-proBNP yielded an AUC of 0.87, which increased to 0.90 when clinical variables were added. Abnormal ECG, elevated hs-cTnI, and elevated NT-proBNP remained independently associated with cardiac syncope. Conclusion: NT-proBNP and hs-cTnI demonstrated significant associations and good diagnostic discrimination for cardiac syncope. Their combined use with clinical characteristics and ECG findings may improve early identification of patients with a cardiac cause of syncope in the emergency department.
Institution: Shifa International Hospital
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7221360195