Etiology and prognosis of patients with unexplained syncope and mid-range left ventricular dysfunction

Francisco‐Pascual, Jaume; Ródenas-Alesina, Eduard; Rivas-Gándara, Núria; Belahnech, Yassin; Olivella, A.; Pérez-Rodón, Jordi; Benito, Begoña; Santos‐Ortega, Alba; Moya-Mitjans, Àngel; Casas, G; Cantalapiedra-Romero, Javier; Maldonado, Jenson; Ferreira‐González, Ignacio

doi:10.1016/j.hrthm.2020.12.009

Cited by 10 publications

(9 citation statements)

References 25 publications

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“…The sonographers performing and the cardiologists reporting the TTE were not aware of and did not calculate the CSRS at any time during the study. Cardiac abnormalities likely to influence diagnosis and further management comprised valvular disease (moderate to severe aortic stenosis with a valve area of ≤1 cm 2 ), left ventricular outflow tract obstruction such as hypertrophic cardiomyopathy, left ventricular systolic dysfunction with an ejection fraction <40% (as more than half of such patients presenting with syncope are subsequently diagnosed as having significant arrhythmias),17 moderate to severe pulmonary hypertension with a mean pulmonary arterial pressure ≥30 mm Hg, coronary artery disease (as evidenced by regional wall motion abnormalities), proximal dissection of the ascending aorta, pericardial tamponade, atrial myxoma/thrombus, or any other structural heart defect likely to cause haemodynamic compromise.…”

Section: Methodsmentioning

confidence: 99%

Appropriate use of transthoracic echocardiography in the investigation of general medicine patients presenting with syncope or presyncope

Simos

Scott

2022

Postgraduate Medical Journal

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Study purposeRoutine transthoracic echocardiography (TTE) in patients with syncope or presyncope is resource-intensive. We assessed if risk thresholds defined by a validated risk score may identify patients at low risk of cardiac abnormality in whom TTE is unnecessary.Study designWe conducted a retrospective study of all general medicine patients with syncope/presyncope presenting to a tertiary hospital between July 2016 and September 2020 and who underwent TTE. The Canadian Syncope Risk Score (CSRS) was used to categorise patients as low to very low risk (score −3 to 0) or moderate to high risk (score ≥1) for serious adverse events at 30 days. A cut-point of 0 was used to calculate the sensitivity, specificity, positive and negative predictive values (PPV and NPV) for CSRS and the odds ratio (OR) of a clinically significant finding on TTE in patients with CSRS ≥1 compared with all patients.ResultsAmong 157 patients, the CSRS categorised 69 (44%) as very low to low risk in whom TTE was normal. In 88 patients deemed moderate to high risk, TTE detected a cardiac abnormality in 24 (27%). A CSRS ≥1 yielded a sensitivity of 100% (95% CI 85.7% to 100%), specificity of 51.1% (95% CI 42.3% to 59.8%), PPV of 26.5% (95% CI 26.3% to 30.1%) and NPV of 100% (95% CI 92.5% to 100%) for cardiac abnormalities and doubled the odds of an abnormality (OR=2.05, 95% CI 1.08 to 3.87, p=0.028).ConclusionIn general medicine patients with syncope/presyncope, using the CSRS to stratify risk of a cardiac abnormality on TTE can almost halve TTE use.

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Section: Methodsmentioning

confidence: 99%

Appropriate use of transthoracic echocardiography in the investigation of general medicine patients presenting with syncope or presyncope

Simos

Scott

2022

Postgraduate Medical Journal

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“…Notably, the left ventricular ejection fraction was preserved in these patients. In comparison, Francisco-Pascual et al 26 recently investigated 104 patients with ILR and midrange left ventricular ejection fraction. They noted a significant rate of pacemaker/ICD implantation in nearly 58%.…”

Section: Coronary Artery Diseasementioning

confidence: 99%

Predictors for the detection of arrhythmia requiring pacemaker/ICD implantation—Results from a loop recorder study

Kreimer

Aweimer

Backhaus

et al. 2022

Pacing Clinical Electrophis

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Background: There are few large studies on which factors are associated with the occurrence of arrhythmias. Implantable loop recorders (ILR) are useful in detecting arrhythmia due to prolonged and continuous ECG monitoring. Therefore, the aim of this study is to identify and evaluate clinical characteristics and ECG parameters for predicting arrhythmias requiring pacemaker/ICD implantation by analyzing a study cohort with ILR. Methods: This bicentric study comprised a study cohort of 451 patients (mean age 64 ± 16 years, 209 women) receiving ILR implantation between 2011 and 2021. Patients were followed up on a 3 monthly outpatient interval. All arrhythmias with a pacemaker or ICD indication were considered clinically relevant. The primary study endpoint was the detection of clinically relevant arrhythmia. Results: During a follow up of 678 ± 392 days, a clinically relevant arrhythmia was detected in 81 of 451 patients (18%). Multivariate analysis revealed five independent

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“…Only when the device is activated (either via manual activation or an automatic arrhythmia detection algorithm), it records on another part of the memory (where it will not be deleted and can be reviewed) the recording from a few minutes before the start of the event until its end. In this way, since several minutes before activation are stored in the device memory, the likelihood of recording the trace at the time of the syncope episode (if it is activated for syncope), or the start of the episode of palpitations, is high[ 2 , 54 , 70 , 71 ].…”

Section: Electrocardographic Cardiac Monitoring Devicesmentioning

confidence: 99%

“…In addition to allowing for a precise diagnosis of certain arrhythmias (such as paroxysmal supraventricular tachycardias), it is possible to treat the arrhythmia with ablation during the procedure in those cases where it is indicated[ 91 - 93 ]. It also allows to evaluate other causes of syncope if present[ 9 , 10 , 94 , 95 ], and performing risk stratification in patients with structural heart disease[ 14 , 71 ]. Since it is an invasive test, it tends to be considered at the end of the diagnostic process, either in patients with a high probability of significant arrhythmia when the monitoring methods have not allowed for it to be documented, or in patients where, after documenting the clinical arrhythmia, ablation treatment is planned.…”

Section: Work-up Of Patients With Palpitationsmentioning

confidence: 99%

Cardiac monitoring for patients with palpitations

Francisco‐Pascual¹,

Cantalapiedra-Romero²,

Pérez-Rodón³

et al. 2021

WJC

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Palpitations are one of the most common reasons for medical consultation. They tend to worry patients and can affect their quality of life. They are often a symptom associated with cardiac rhythm disorders, although there are other etiologies. For diagnosis, it is essential to be able to reliably correlate the symptoms with an electrocardiographic record allowing the identification or ruling out of a possible rhythm disorder. However, reaching a diagnosis is not always simple, given that they tend to be transitory symptoms and the patient is frequently asymptomatic at the time of assessment. In recent years, electrocardiographic monitoring systems have incorporated many technical improvements that solve several of the 24-h Holter monitor limitations. The objective of this review is to provide an update on the different monitoring methods currently available, remarking their indications and limitations, to help healthcare professionals to appropriately select and use them in the work-up of patients with palpitations.

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Etiology and prognosis of patients with unexplained syncope and mid-range left ventricular dysfunction

Cited by 10 publications

References 25 publications

Appropriate use of transthoracic echocardiography in the investigation of general medicine patients presenting with syncope or presyncope

Appropriate use of transthoracic echocardiography in the investigation of general medicine patients presenting with syncope or presyncope

Predictors for the detection of arrhythmia requiring pacemaker/ICD implantation—Results from a loop recorder study

Cardiac monitoring for patients with palpitations

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