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Early and late-onset syncope : insight into mechanisms

Torabi, Parisa LU orcid ; Rivasi, Giulia ; Hamrefors, Viktor LU orcid ; Ungar, Andrea ; Sutton, Richard LU ; Brignole, Michele and Fedorowski, Artur LU orcid (2022) In European Heart Journal 43(22). p.2116-2123
Abstract

AIMS: Unexplained syncope is an important clinical challenge. The influence of age at first syncope on the final syncope diagnosis is not well studied.

METHODS AND RESULTS: Consecutive head-up tilt patients (n = 1928) evaluated for unexplained syncope were stratified into age groups <30, 30-59, and ≥60 years based on age at first syncope. Clinical characteristics and final syncope diagnosis were analysed in relation to age at first syncope and age at investigation. The age at first syncope had a bimodal distribution with peaks at 15 and 70 years. Prodromes (64 vs. 26%, P < 0.001) and vasovagal syncope (VVS, 59 vs. 19%, P < 0.001) were more common in early-onset (<30 years) compared with late-onset (≥60 years) syncope.... (More)

AIMS: Unexplained syncope is an important clinical challenge. The influence of age at first syncope on the final syncope diagnosis is not well studied.

METHODS AND RESULTS: Consecutive head-up tilt patients (n = 1928) evaluated for unexplained syncope were stratified into age groups <30, 30-59, and ≥60 years based on age at first syncope. Clinical characteristics and final syncope diagnosis were analysed in relation to age at first syncope and age at investigation. The age at first syncope had a bimodal distribution with peaks at 15 and 70 years. Prodromes (64 vs. 26%, P < 0.001) and vasovagal syncope (VVS, 59 vs. 19%, P < 0.001) were more common in early-onset (<30 years) compared with late-onset (≥60 years) syncope. Orthostatic hypotension (OH, 3 vs. 23%, P < 0.001), carotid sinus syndrome (CSS, 0.6 vs. 9%, P < 0.001), and complex syncope (>1 concurrent diagnosis; 14 vs. 26%, P < 0.001) were more common in late-onset syncope. In patients aged ≥60 years, 12% had early-onset and 70% had late-onset syncope; older age at first syncope was associated with higher odds of OH (+31% per 10-year increase, P < 0.001) and CSS (+26%, P = 0.004). Younger age at first syncope was associated with the presence of prodromes (+23%, P < 0.001) and the diagnoses of VVS (+22%, P < 0.001) and complex syncope (+9%, P = 0.018).

CONCLUSION: In patients with unexplained syncope, first-ever syncope incidence has a bimodal lifetime pattern with peaks at 15 and 70 years. The majority of older patients present only recent syncope; OH and CSS are more common in this group. In patients with early-onset syncope, prodromes, VVS, and complex syncope are more common.

KEY QUESTION: Does the age at which patients experience syncope for the first time impact the final syncope diagnosis?

KEY FINDING: The first-ever syncope incidence has a bimodal lifetime pattern. The majority of older patients present recent syncope; orthostatic hypotension and carotid sinus syndrome are more common in this group. In patients with early-onset syncope, vasovagal and complex syncope are more common.

TAKE-HOME MESSAGE: The age at first syncope impacts the final diagnosis. A detailed syncope history remains essential in elderly patients evaluated for syncope.

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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
European Heart Journal
volume
43
issue
22
article number
ehac017
pages
2116 - 2123
publisher
Oxford University Press
external identifiers
  • scopus:85131342860
  • pmid:35139180
ISSN
1522-9645
DOI
10.1093/eurheartj/ehac017
language
English
LU publication?
yes
additional info
© The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Cardiology.
id
4aeaa561-29ae-453d-b37c-8747f0038d8f
date added to LUP
2022-02-11 15:45:42
date last changed
2024-06-27 11:22:27
@article{4aeaa561-29ae-453d-b37c-8747f0038d8f,
  abstract     = {{<p>AIMS: Unexplained syncope is an important clinical challenge. The influence of age at first syncope on the final syncope diagnosis is not well studied.</p><p>METHODS AND RESULTS: Consecutive head-up tilt patients (n = 1928) evaluated for unexplained syncope were stratified into age groups &lt;30, 30-59, and ≥60 years based on age at first syncope. Clinical characteristics and final syncope diagnosis were analysed in relation to age at first syncope and age at investigation. The age at first syncope had a bimodal distribution with peaks at 15 and 70 years. Prodromes (64 vs. 26%, P &lt; 0.001) and vasovagal syncope (VVS, 59 vs. 19%, P &lt; 0.001) were more common in early-onset (&lt;30 years) compared with late-onset (≥60 years) syncope. Orthostatic hypotension (OH, 3 vs. 23%, P &lt; 0.001), carotid sinus syndrome (CSS, 0.6 vs. 9%, P &lt; 0.001), and complex syncope (&gt;1 concurrent diagnosis; 14 vs. 26%, P &lt; 0.001) were more common in late-onset syncope. In patients aged ≥60 years, 12% had early-onset and 70% had late-onset syncope; older age at first syncope was associated with higher odds of OH (+31% per 10-year increase, P &lt; 0.001) and CSS (+26%, P = 0.004). Younger age at first syncope was associated with the presence of prodromes (+23%, P &lt; 0.001) and the diagnoses of VVS (+22%, P &lt; 0.001) and complex syncope (+9%, P = 0.018).</p><p>CONCLUSION: In patients with unexplained syncope, first-ever syncope incidence has a bimodal lifetime pattern with peaks at 15 and 70 years. The majority of older patients present only recent syncope; OH and CSS are more common in this group. In patients with early-onset syncope, prodromes, VVS, and complex syncope are more common.</p><p>KEY QUESTION: Does the age at which patients experience syncope for the first time impact the final syncope diagnosis?</p><p>KEY FINDING: The first-ever syncope incidence has a bimodal lifetime pattern. The majority of older patients present recent syncope; orthostatic hypotension and carotid sinus syndrome are more common in this group. In patients with early-onset syncope, vasovagal and complex syncope are more common.</p><p>TAKE-HOME MESSAGE: The age at first syncope impacts the final diagnosis. A detailed syncope history remains essential in elderly patients evaluated for syncope.</p>}},
  author       = {{Torabi, Parisa and Rivasi, Giulia and Hamrefors, Viktor and Ungar, Andrea and Sutton, Richard and Brignole, Michele and Fedorowski, Artur}},
  issn         = {{1522-9645}},
  language     = {{eng}},
  month        = {{02}},
  number       = {{22}},
  pages        = {{2116--2123}},
  publisher    = {{Oxford University Press}},
  series       = {{European Heart Journal}},
  title        = {{Early and late-onset syncope : insight into mechanisms}},
  url          = {{http://dx.doi.org/10.1093/eurheartj/ehac017}},
  doi          = {{10.1093/eurheartj/ehac017}},
  volume       = {{43}},
  year         = {{2022}},
}