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- Torabi, Parisa, et al.
(författare)
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Definitive aetiology of unexplained syncope after cardiovascular autonomic tests in a tertiary syncope unit
- 2023
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Ingår i: 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. - 1532-2092. ; 25:9
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Tidskriftsartikel (refereegranskat)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 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.
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