Definitive aetiology of unexplained syncope after cardiovascular autonomic tests in a tertiary syncope unit
Torabi, Parisa LU
; Hamrefors, Viktor
LU
; Sutton, Richard
LU
; Brignole, Michele
and Fedorowski, Artur
LU
(2023)
In Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
25(9).
- Abstract
BACKGROUND AND AIM: Syncope is a common condition with many possible causes, ranging from benign to life-threatening aetiologies. Establishing a diagnosis can be difficult and specialized syncope units, using cardiovascular autonomic tests (CAT) including head-up tilt test can increase the diagnostic yield. However, up to one fifth of examined patients have inconclusive CAT results. The aim of the present study was to investigate the predictive value of history and clinical findings for unexplained syncope after CAT and characterize the group with negative results.
METHODS AND RESULTS: Consecutive syncope patients (n = 2663, 61% women, median age 52 [32-69] years) were evaluated and CAT explained aetiology of syncope in 79% of... (More)
BACKGROUND AND AIM: Syncope is a common condition with many possible causes, ranging from benign to life-threatening aetiologies. Establishing a diagnosis can be difficult and specialized syncope units, using cardiovascular autonomic tests (CAT) including head-up tilt test can increase the diagnostic yield. However, up to one fifth of examined patients have inconclusive CAT results. The aim of the present study was to investigate the predictive value of history and clinical findings for unexplained syncope after CAT and characterize the group with negative results.
METHODS AND RESULTS: Consecutive syncope patients (n = 2663, 61% women, median age 52 [32-69] years) were evaluated and CAT explained aetiology of syncope in 79% of cases, whereas 21% remained unexplained. Predictors of negative CAT were older age at first syncope (+8% higher odds per 10-year increment, p = 0.042), higher supine HR (+12% per 10 beat-per-minute; p = 0.003), absence of prodromes (+48%; p < 0.001), hypertension (+45%; p = 0.003), diabetes (+82%; p < 0.001), heart failure (+98%; p = 0.014) and coronary artery disease (+51%; p = 0.027). Compared with vasovagal syncope, patients with negative CAT were older, reported more often absence of prodromes and had a higher burden of cardiovascular comorbidities.
CONCLUSION: Cardiovascular autonomic testing established cause of syncope in 79% of patients evaluated in a syncope unit. Syncope without prodromes and cardiovascular comorbidities were significant predictors of failure to reveal an aetiology from assessment by CAT. These are known risk factors for cardiac syncope and patients with inconclusive CAT warrant further investigation.
(Less)
- author
- Torabi, Parisa
LU
; Hamrefors, Viktor
LU
; Sutton, Richard
LU
; Brignole, Michele
and Fedorowski, Artur
LU
- organization
- publishing date
- 2023-08-17
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
- volume
- 25
- issue
- 9
- publisher
- Oxford University Press
- external identifiers
-
- pmid:37589189
- ISSN
- 1532-2092
- DOI
- 10.1093/europace/euad247
- language
- English
- LU publication?
- yes
- additional info
- © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.
- id
- 5da05ad1-da78-4487-8353-3f03ed4a1626
- date added to LUP
- 2023-08-19 14:25:19
- date last changed
- 2023-11-19 03:00:03
@article{5da05ad1-da78-4487-8353-3f03ed4a1626,
abstract = {{<p>BACKGROUND AND AIM: Syncope is a common condition with many possible causes, ranging from benign to life-threatening aetiologies. Establishing a diagnosis can be difficult and specialized syncope units, using cardiovascular autonomic tests (CAT) including head-up tilt test can increase the diagnostic yield. However, up to one fifth of examined patients have inconclusive CAT results. The aim of the present study was to investigate the predictive value of history and clinical findings for unexplained syncope after CAT and characterize the group with negative results.</p><p>METHODS AND RESULTS: Consecutive syncope patients (n = 2663, 61% women, median age 52 [32-69] years) were evaluated and CAT explained aetiology of syncope in 79% of cases, whereas 21% remained unexplained. Predictors of negative CAT were older age at first syncope (+8% higher odds per 10-year increment, p = 0.042), higher supine HR (+12% per 10 beat-per-minute; p = 0.003), absence of prodromes (+48%; p < 0.001), hypertension (+45%; p = 0.003), diabetes (+82%; p < 0.001), heart failure (+98%; p = 0.014) and coronary artery disease (+51%; p = 0.027). Compared with vasovagal syncope, patients with negative CAT were older, reported more often absence of prodromes and had a higher burden of cardiovascular comorbidities.</p><p>CONCLUSION: Cardiovascular autonomic testing established cause of syncope in 79% of patients evaluated in a syncope unit. Syncope without prodromes and cardiovascular comorbidities were significant predictors of failure to reveal an aetiology from assessment by CAT. These are known risk factors for cardiac syncope and patients with inconclusive CAT warrant further investigation.</p>}},
author = {{Torabi, Parisa and Hamrefors, Viktor and Sutton, Richard and Brignole, Michele and Fedorowski, Artur}},
issn = {{1532-2092}},
language = {{eng}},
month = {{08}},
number = {{9}},
publisher = {{Oxford University Press}},
series = {{Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology}},
title = {{Definitive aetiology of unexplained syncope after cardiovascular autonomic tests in a tertiary syncope unit}},
url = {{http://dx.doi.org/10.1093/europace/euad247}},
doi = {{10.1093/europace/euad247}},
volume = {{25}},
year = {{2023}},
}