Diagnostic role of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in pediatric syncope in the emergency department: a prospective study.

Authors

Sinem Dedeoglu, Caner Turan, Eser Dogan, Seda Kanmaz, Muazzez Seker Gezici, Elif Azarsiz, Ali Yurtseven, Eylem Ulas Saz

Published in

European journal of pediatrics. Volume 185. Issue 9. Aug 07, 2026. Epub Aug 07, 2026.

Abstract

Cardiac syncope in children is a critical risk and demands a prompt, accurate diagnosis. This study aimed to elucidate the diagnostic efficacy and clinical relevance of N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in distinguishing between cardiac and non-cardiac syncope in children. A prospective study was conducted in a tertiary pediatric emergency department (ED), enrolling patients who were diagnosed with syncope. Conventional cardiac biomarkers, serum NT-proBNP, telecardiography, and 12-lead electrocardiography were performed. All patients underwent echocardiography, while TILT testing and 24-h Holter monitoring were performed by a pediatric cardiologist in a subset of patients. Electroencephalography (EEG) was performed after cardiac syncope had been ruled out and the patient had been evaluated by a pediatric neurologist. Overall, 197 patients and 50 healthy children were included. Cardiac etiology was identified in 8.6% of patients, while vasovagal, idiopathic, neurologic, orthostatic, and psychogenic syncope accounted for 27.9%, 28.9%, 15.2%, 5.6%, and 7.6% of cases, respectively. The TILT test was performed on only 19.8% of patients, and 46.2% were positive. The median serum NT-proBNP levels were 437.4 ng/L, 44.5 ng/L, and 37.1 ng/L in children with cardiac syncope, non-cardiac syncope, and healthy children (p < 0.001, p = 0.008, and p = 0.971, respectively). The optimum diagnostic cut-off point for cardiac syncope in 7-18-year-old children was 145.0 ng/L, the AUROC was 0.761 (95% CI:0.589-0.934), sensitivity 64.3%, specificity 98.2%, PPV 75.0%, and NPV 97.1%. Conclusion: Serum NT-proBNP levels have been shown to be a promising biomarker for predicting cardiac syncope in children. An NT-proBNP level above 145 ng/L may help identify children at increased risk of a cardiac etiology.

PMID:
42566053
Bibliographic data and abstract were imported from PubMed on 07 Aug 2026.

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