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Structural heart disease as the cause of syncope
We described the clinical evolution of patients with structural heart disease presenting at the emergency room with syncope. Patients were stratified according to their syncope etiology and available scores for syncope prognostication. Cox proportional hazard models were used to investigate the rela...
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| Published in: | Brazilian journal of medical and biological research 2018-01, Vol.51 (4), p.e6989-e6989 |
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| container_end_page | e6989 |
| container_issue | 4 |
| container_start_page | e6989 |
| container_title | Brazilian journal of medical and biological research |
| container_volume | 51 |
| creator | Guimarães, R B Essebag, V Furlanetto, M Yanez, J P G Farina, M G Garcia, D Almeida, E D Stephan, L Lima, G G Leiria, T L L |
| description | We described the clinical evolution of patients with structural heart disease presenting at the emergency room with syncope. Patients were stratified according to their syncope etiology and available scores for syncope prognostication. Cox proportional hazard models were used to investigate the relationship between etiology of the syncope and event-free survival. Of the 82,678 emergency visits during the study period, 160 (0.16%) patients were there due to syncope, having a previous diagnosis of structural heart disease. During the median follow-up of 33.8±13.8 months, mean age at the qualifying syncope event was 68.3 years and 40.6% of patients were male. Syncope was vasovagal in 32%, cardiogenic in 57%, orthostatic hypotension in 6%, and of unknown causes in 5% of patients. The primary composite endpoint death, readmission, and emergency visit in 30 days was 39.4% in vasovagal syncope and 60.6% cardiogenic syncope (P |
| doi_str_mv | 10.1590/1414-431X20176989 |
| format | article |
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Patients were stratified according to their syncope etiology and available scores for syncope prognostication. Cox proportional hazard models were used to investigate the relationship between etiology of the syncope and event-free survival. Of the 82,678 emergency visits during the study period, 160 (0.16%) patients were there due to syncope, having a previous diagnosis of structural heart disease. During the median follow-up of 33.8±13.8 months, mean age at the qualifying syncope event was 68.3 years and 40.6% of patients were male. Syncope was vasovagal in 32%, cardiogenic in 57%, orthostatic hypotension in 6%, and of unknown causes in 5% of patients. The primary composite endpoint death, readmission, and emergency visit in 30 days was 39.4% in vasovagal syncope and 60.6% cardiogenic syncope (P<0.001). Primary endpoint-free survival was lower for patients with cardiogenic syncope (HR=2.97, 95%CI=1.94-4.55; P<0.001). The scores were analyzed for diagnostic performance with area under the curve (AUC) and did not help differentiate patients with an increased risk of adverse events. The differential diagnosis of syncope causes in patients with structural heart disease is important, because vasovagal and postural hypotension have better survival and less probability of emergency room or hospital readmission. The available scores are not reliable tools for prognosis in this specific patient population.</description><identifier>ISSN: 0100-879X</identifier><identifier>ISSN: 1414-431X</identifier><identifier>EISSN: 1414-431X</identifier><identifier>EISSN: 1678-4510</identifier><identifier>DOI: 10.1590/1414-431X20176989</identifier><identifier>PMID: 29513795</identifier><language>eng</language><publisher>Brazil: Associacao Brasileira de Divulgacao Cientifica (ABDC)</publisher><subject>Aged ; BIOLOGY ; Brazil - epidemiology ; Cardiomyopathies - complications ; Cardiovascular disease ; Cohort Studies ; Complications and side effects ; Coronary artery disease ; Diagnosis ; Differential diagnosis ; Disease-Free Survival ; Electrocardiography ; Emergency ; Emergency medical care ; Emergency Medical Services - statistics & numerical data ; Etiology ; Fainting ; Female ; Heart ; Heart diseases ; Heart Diseases - complications ; Heart Diseases - epidemiology ; Hospitalization ; Humans ; Hypotension ; Male ; Management ; Medical prognosis ; MEDICINE, RESEARCH & EXPERIMENTAL ; Posture ; Proportional Hazards Models ; Risk Factors ; Structural heart ; Survival ; Survival Analysis ; Syncope ; Syncope - etiology ; Syncope - mortality ; Vasovagal syncope</subject><ispartof>Brazilian journal of medical and biological research, 2018-01, Vol.51 (4), p.e6989-e6989</ispartof><rights>COPYRIGHT 2018 Associacao Brasileira de Divulgacao Cientifica (ABDC)</rights><rights>Copyright Revista Brasileira de Pesquisas Medicas 2018</rights><rights>This work is licensed under a Creative Commons Attribution 4.0 International License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c630t-60341d6294edbf400441ce6023a0abf95f32f3d6af218fe65ed605f8a82c0c0b3</citedby><cites>FETCH-LOGICAL-c630t-60341d6294edbf400441ce6023a0abf95f32f3d6af218fe65ed605f8a82c0c0b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,24150,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29513795$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Guimarães, R B</creatorcontrib><creatorcontrib>Essebag, V</creatorcontrib><creatorcontrib>Furlanetto, M</creatorcontrib><creatorcontrib>Yanez, J P G</creatorcontrib><creatorcontrib>Farina, M G</creatorcontrib><creatorcontrib>Garcia, D</creatorcontrib><creatorcontrib>Almeida, E D</creatorcontrib><creatorcontrib>Stephan, L</creatorcontrib><creatorcontrib>Lima, G G</creatorcontrib><creatorcontrib>Leiria, T L L</creatorcontrib><title>Structural heart disease as the cause of syncope</title><title>Brazilian journal of medical and biological research</title><addtitle>Braz J Med Biol Res</addtitle><description>We described the clinical evolution of patients with structural heart disease presenting at the emergency room with syncope. Patients were stratified according to their syncope etiology and available scores for syncope prognostication. Cox proportional hazard models were used to investigate the relationship between etiology of the syncope and event-free survival. Of the 82,678 emergency visits during the study period, 160 (0.16%) patients were there due to syncope, having a previous diagnosis of structural heart disease. During the median follow-up of 33.8±13.8 months, mean age at the qualifying syncope event was 68.3 years and 40.6% of patients were male. Syncope was vasovagal in 32%, cardiogenic in 57%, orthostatic hypotension in 6%, and of unknown causes in 5% of patients. The primary composite endpoint death, readmission, and emergency visit in 30 days was 39.4% in vasovagal syncope and 60.6% cardiogenic syncope (P<0.001). Primary endpoint-free survival was lower for patients with cardiogenic syncope (HR=2.97, 95%CI=1.94-4.55; P<0.001). The scores were analyzed for diagnostic performance with area under the curve (AUC) and did not help differentiate patients with an increased risk of adverse events. The differential diagnosis of syncope causes in patients with structural heart disease is important, because vasovagal and postural hypotension have better survival and less probability of emergency room or hospital readmission. The available scores are not reliable tools for prognosis in this specific patient population.</description><subject>Aged</subject><subject>BIOLOGY</subject><subject>Brazil - epidemiology</subject><subject>Cardiomyopathies - complications</subject><subject>Cardiovascular disease</subject><subject>Cohort Studies</subject><subject>Complications and side effects</subject><subject>Coronary artery disease</subject><subject>Diagnosis</subject><subject>Differential diagnosis</subject><subject>Disease-Free Survival</subject><subject>Electrocardiography</subject><subject>Emergency</subject><subject>Emergency medical care</subject><subject>Emergency Medical Services - statistics & numerical data</subject><subject>Etiology</subject><subject>Fainting</subject><subject>Female</subject><subject>Heart</subject><subject>Heart diseases</subject><subject>Heart Diseases - complications</subject><subject>Heart Diseases - epidemiology</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Hypotension</subject><subject>Male</subject><subject>Management</subject><subject>Medical prognosis</subject><subject>MEDICINE, RESEARCH & EXPERIMENTAL</subject><subject>Posture</subject><subject>Proportional Hazards Models</subject><subject>Risk Factors</subject><subject>Structural heart</subject><subject>Survival</subject><subject>Survival Analysis</subject><subject>Syncope</subject><subject>Syncope - etiology</subject><subject>Syncope - mortality</subject><subject>Vasovagal syncope</subject><issn>0100-879X</issn><issn>1414-431X</issn><issn>1414-431X</issn><issn>1678-4510</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>DOA</sourceid><recordid>eNpdUk1r3DAUNKWl2ab9Ab0UQ6H04vTp0_KlEEI_AoEe0kJuQpafdrV4ra1kh-bfV-4mm7j4YPQ0M5o3TFG8JXBGRAOfCCe84ozcUCC1bFTzrFgdZ8-LFRCAStXNzUnxKqUtABXAycvihDaCsLoRqwKuxzjZcYqmLzdo4lh2PqFJWJpUjhssrZnyIbgy3Q027PF18cKZPuGb-_9p8evrl58X36urH98uL86vKisZjJUExkknacOxax0H4JxYlECZAdO6RjhGHeukcZQoh1JgJ0E4ZRS1YKFlp8XlQbcLZqv30e9MvNPBeP1vEOJaZ7fe9qjb1irrWqyplFygVXWtuCV1PhvaoMpaZwetZD32QW_DFIdsXl_PCek5oZygguwSQBKZCZ8PhP3U7rCzOIw5oIWL5c3gN3odbrVQQnImssDHe4EYfk-YRr3zyWLfmwHDlHR-jhLCqYIMff8f9GiPElpzSqXgj6i1yRv7wYX8rp1F9blg8-ZNzR8XXaDy1-HO2zCg83m-IHx4QsgF6MdNCv00-jCkJZAcgDaGlCK6YxgE9FxGPRdP5-L9eShj5rx7muKR8dA-9hdlo9PL</recordid><startdate>20180101</startdate><enddate>20180101</enddate><creator>Guimarães, R B</creator><creator>Essebag, V</creator><creator>Furlanetto, M</creator><creator>Yanez, J P G</creator><creator>Farina, M G</creator><creator>Garcia, D</creator><creator>Almeida, E D</creator><creator>Stephan, L</creator><creator>Lima, G G</creator><creator>Leiria, T L L</creator><general>Associacao Brasileira de Divulgacao Cientifica (ABDC)</general><general>Revista Brasileira de Pesquisas Medicas</general><general>Associação Brasileira de Divulgação Científica</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>INF</scope><scope>7QG</scope><scope>7QP</scope><scope>7QR</scope><scope>7TK</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>P64</scope><scope>7X8</scope><scope>5PM</scope><scope>GPN</scope><scope>DOA</scope></search><sort><creationdate>20180101</creationdate><title>Structural heart disease as the cause of syncope</title><author>Guimarães, R B ; 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Patients were stratified according to their syncope etiology and available scores for syncope prognostication. Cox proportional hazard models were used to investigate the relationship between etiology of the syncope and event-free survival. Of the 82,678 emergency visits during the study period, 160 (0.16%) patients were there due to syncope, having a previous diagnosis of structural heart disease. During the median follow-up of 33.8±13.8 months, mean age at the qualifying syncope event was 68.3 years and 40.6% of patients were male. Syncope was vasovagal in 32%, cardiogenic in 57%, orthostatic hypotension in 6%, and of unknown causes in 5% of patients. The primary composite endpoint death, readmission, and emergency visit in 30 days was 39.4% in vasovagal syncope and 60.6% cardiogenic syncope (P<0.001). Primary endpoint-free survival was lower for patients with cardiogenic syncope (HR=2.97, 95%CI=1.94-4.55; P<0.001). The scores were analyzed for diagnostic performance with area under the curve (AUC) and did not help differentiate patients with an increased risk of adverse events. The differential diagnosis of syncope causes in patients with structural heart disease is important, because vasovagal and postural hypotension have better survival and less probability of emergency room or hospital readmission. The available scores are not reliable tools for prognosis in this specific patient population.</abstract><cop>Brazil</cop><pub>Associacao Brasileira de Divulgacao Cientifica (ABDC)</pub><pmid>29513795</pmid><doi>10.1590/1414-431X20176989</doi><oa>free_for_read</oa></addata></record> |
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| issn | 0100-879X 1414-431X 1414-431X 1678-4510 |
| language | eng |
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| source | SciELO Brazil; IngentaConnect Journals |
| subjects | Aged BIOLOGY Brazil - epidemiology Cardiomyopathies - complications Cardiovascular disease Cohort Studies Complications and side effects Coronary artery disease Diagnosis Differential diagnosis Disease-Free Survival Electrocardiography Emergency Emergency medical care Emergency Medical Services - statistics & numerical data Etiology Fainting Female Heart Heart diseases Heart Diseases - complications Heart Diseases - epidemiology Hospitalization Humans Hypotension Male Management Medical prognosis MEDICINE, RESEARCH & EXPERIMENTAL Posture Proportional Hazards Models Risk Factors Structural heart Survival Survival Analysis Syncope Syncope - etiology Syncope - mortality Vasovagal syncope |
| title | Structural heart disease as the cause of syncope |
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