Author + information
- Jose Plutarco Gutierrez Yanez,
- Tiago Luiz Luz Leiria,
- Raphael Boesche Guimaraes,
- Gustavo Glotz De Lima,
- Maico Furlanetto and
- Matias Galeazzi Farina
Background: Patients with structural heart disease can have syncope due to their cardiac pathology, although some patients may have other underlying mechanisms for the loss of consciousness. Our study sought to describe the clinical evolution of patients with structural heart disease who came to the emergency room with syncope stratifying then by the etiology of the syncopal episode and according the available scores for prognostication in syncope.
Methods: This was a single center cohort study of patients diagnosed with syncope and structural heart disease in the emergency department of our Institution from January 1st, 2012, to December 31st, 2013 that were followed for 52 months after the index episode. Our primary outcome was a combination of death, unscheduled emergency room visit and hospital readmission. Patients where stratified according to their syncope etiology and also by they risk according to different syncope scores.
Results: 160 patients were selected for having syncope and diagnosis of structural heart disease. The attending physician diagnosed syncope as vasovagal in 57 (36%), cardiogenic 87 (54%), orthostatic hypotension 10 (6%) and due to unknown causes 6 cases respectively (4%). The mean follow-up was 33.8 months. Survival free of the primary endpoint was lower for patients with cardiogenic syncope. Multivariable regression showed that patients with cardiogenic syncope had an odds ratio of 3.23 (95%CI: 1.48 −7.07; P=0.03) for the primary outcome when compared with those diagnosed with vasovagal syncope. There was no difference in the incidence of death during the follow-up among the different syncope etiologies. The available scores did not help to differentiate those with an increased risk of adverse events.
Conclusions: The differential diagnosis between vasovagal, cardiogenic or postural hypotension syncope is very important, because even those patients with structural heart disease, vasovagal and postural hypotension have a better survival and less probability of death, return to the emergency room and hospital readmission. The available scores are not reliable tools for prognostication in this particular patient population.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Arrhythmias and Clinical EP: Syncope and Other EP Issues
Abstract Category: 6. Arrhythmias and Clinical EP: Other
Presentation Number: 1279-087
- 2017 American College of Cardiology Foundation