Implications of a History of Syncope in Patients Hospitalized With Heart Failure

El‐Menyar, Ayman; Sulaiman, Kadhim; AlSadawi, Ali; Alsheikh‐Ali, Alawi A.; AlMahameed, Wael; Bazargani, Nooshin; Al‐Motarreb, Ahmed; Amin, Haitham; Asaad, Nidal; Habib, Khalid; Ridha, Mustafa; Al‐Jarallah, Mohammed; Al-Thani, Hassan; AlFaleh, Husam; Singh, Rajvir; Panduranga, Prashanth; Suwaidi, Jassim Al

doi:10.1177/0003319716647320

Cited by 3 publications

(3 citation statements)

References 27 publications

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“…In this study, the proportions in group S classified as high-risk and moderately high-risk were greater than those of group NS, and the mortality rate in group S was also higher, reaching 17.2%, which was consistent with previous studies [17]. Sulaiman et al [18] found that a previous history of syncope is one of the independent risk factors for increased mortality during hospitalization, especially in elderly patients. Autopsy studies on PE patients also confirmed that the prominent symptoms in PE patients included the sudden syncope.…”

Section: Variablesupporting

confidence: 92%

Three-Dimensional Reconstruction Algorithm for CT Pulmonary Angiography in Patients with Pulmonary Embolism Combined with Syncope

Zhang¹,

Zhang²,

Wang³

et al. 2021

Scientific Programming

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This paper aimed to study the clinical characteristics of patients with pulmonary embolism (PE) with syncope (PE + S) based on the three-dimensional (3D) reconstruction algorithm in computed tomography (CT) pulmonary angiography (CTPA). In this study, 857 patients with acute PE (APE) who were treated in hospital were selected as the research objects and divided into syncope group (group S) and nonsyncope group (group NS). The 3D reconstruction marching cubes (3DR-MC) algorithm was compared with the traditional MC (T-MC) algorithm and the mesh simplification MC (MMS-MC) algorithm, and the results proved that the running time of the 3DR-MC algorithm on the platform was shorter than that of the other two algorithms. The incidence of syncope in group S in women was higher than that in group NS (51.7% vs. 38.2%). The incidence of syncope classified as high risk in group S was higher than that in group NS, and the mortality rate of pulmonary embolism patients with syncope was higher, and the difference was statistically significant (χ2 = 113.332, P < 0.05 ). The incidence of syncope in group S was higher than that in group NS (χ2 = 4.074, P < 0.05 ). In short, hypertension was an independent risk factor for syncope. PE + S patients could be diagnosed and treated as early as possible based on the clinical characteristics, so as to reduce the adverse consequences of misdiagnosis.

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Section: Variablesupporting

confidence: 92%

Three-Dimensional Reconstruction Algorithm for CT Pulmonary Angiography in Patients with Pulmonary Embolism Combined with Syncope

Zhang¹,

Zhang²,

Wang³

et al. 2021

Scientific Programming

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“…A previous report showed that a history of syncope was a risk factor for in-hospital mortality (odds ratio: 2.61) in patients with HF, 11) indicating that the management of syncope is clinically important for HF patients. Kelly et al 10) revealed that a low dose of disopyramide could not completely suppress vasovagal syncope, and that a trough blood concentration level of at least 3.2 mg/mL is required.…”

Section: Discussionmentioning

confidence: 97%

Evaluation of Disopyramide Efficacy for Refractory Syncope in Heart Failure with Preserved Ejection Fraction Using Holter Electrocardiography: A Case Report

et al. 2022

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The management of syncope is clinically important for heart failure (HF) patients. We herein describe a case on the e‹cacy of disopyramide for refractory syncope in HF with preserved ejection fraction (HFpEF). An 82-year-old man was hospitalized for respiratory distress and lower limb edema and was subsequently diagnosed with HFpEF. The use of diuretics improved HF symptoms; however, on day 10 after hospitalization, a rapid decrease in blood pressure and transient loss of consciousness developed. After neurologic examination, he was diagnosed with pure autonomic failure. Although he was administered midodrine 8 mg/d, ‰udrocortisone 0.1 mg/d, and droxidopa 300 mg/d, syncope was observed once a day on average. According to the Holter electrocardiogram, the patient's heart rate and coe‹cient of variation of R-R intervals (CVRR) during the day were unstable. In addition, high frequency power (parasympathetic nerve activity) was signiˆcantly higher than low frequency power (both sympathetic and parasympathetic nerves activity), suggesting that the parasympathetic nerves may have been highly active while the sympathetic nerves would have been blocked. On day 29, a pharmacist proposed disopyramide 300 mg/d, which blocks parasympathetic nerves and improves neural-mediated syncope, to the attending doctor. After the initiation of disopyramide, transient loss of consciousness was not observed. Furthermore, the diurnal variation in the heart rate and CVRR completely disappeared. In conclusion, disopyramide would be eŠective for refractory syncope in patients with HFpEF, and the Holter electrocardiogram may be a useful tool for the assessment of drug e‹cacy by pharmacists.

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“…Syncopal episodes are associated not only with arrhythmia but also with LV dysfunction—even regardless of the LVEF . Patients with HF with syncopal episodes show more often LV dysfunction than patients with HF without HoS.…”

Section: Introductionmentioning

confidence: 99%

Syncopes and clinical outcome in heart failure: results from prospective clinical study data in Germany

et al. 2020

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Aims Whereas syncopal episodes are a frequent complication of cardiovascular disorders, including heart failure (HF), little is known whether syncopes impact the prognosis of patients with HF. We aimed to assess the impact of a history of syncope (HoS) on overall and hospitalization-free survival of these patients. Methods and resultsWe pooled the data of prospective, nationwide, multicentre studies conducted within the framework of the German Competence Network for Heart Failure including 11 335 subjects. Excluding studies with follow-up periods <10 years, we assessed 5318 subjects. We excluded a study focusing on cardiac changes in patients with an HIV infection because of possible confounding factors and 849 patients due to either missing key parameters or missing follow-up data, resulting in 3594 eligible subjects, including 2130 patients with HF [1564 patients with heart failure with reduced ejection fraction (HFrEF), 314 patients with heart failure with mid-range ejection fraction, and 252 patients with heart failure with preserved ejection fraction (HFpEF)] and 1464 subjects without HF considered as controls. HoS was more frequent in the overall cohort of patients with HF compared with controls (P < 0.001)-mainly driven by the HFpEF subgroup (HFpEF vs. controls: 25.0% vs. 12.8%, P < 0.001). Of all the subjects, 14.6% reported a HoS. Patients with HFrEF in our pooled cohort showed more often syncopes than subjects without HF (15.0% vs. 12.8%, P = 0.082). Subjects with HoS showed worse overall survival [42.4% vs. 37.9%, hazard ratio (HR) = 1.21, 99% confidence interval (0.99, 1.46), P = 0.04] and less days alive out of hospital [HR = 1.39, 99% confidence interval (1.18, 1.64), P < 0.001] compared with all subjects without HoS. Patients with HFrEF with HoS died earlier [30.3% vs. 41.6%, HR = 1.40, 99% confidence interval (1.12, 1.74), P < 0.001] and lived fewer days out of hospital than those without HoS. We could not find these changes in mortality and hospital-free survival in the heart failure with mid-range ejection fraction and HFpEF cohorts. HoS represented a clinically high-risk profile within the HFrEF group-combining different risk factors. Further analyses showed that among patients with HFrEF with HoS, known cardiovascular risk factors (e.g. age, male sex, diabetes mellitus, and anaemia) were more prevalent. These constellations of the risk factors explained the effect of HoS in a multivariable Cox regression models. Conclusions In a large cohort of patients with HF, HoS was found to be a clinically and easily accessible predictor of both overall and hospitalization-free survival in patients with HFrEF and should thus routinely be assessed.

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Implications of a History of Syncope in Patients Hospitalized With Heart Failure

Cited by 3 publications

References 27 publications

Three-Dimensional Reconstruction Algorithm for CT Pulmonary Angiography in Patients with Pulmonary Embolism Combined with Syncope

Three-Dimensional Reconstruction Algorithm for CT Pulmonary Angiography in Patients with Pulmonary Embolism Combined with Syncope

Evaluation of Disopyramide Efficacy for Refractory Syncope in Heart Failure with Preserved Ejection Fraction Using Holter Electrocardiography: A Case Report

Syncopes and clinical outcome in heart failure: results from prospective clinical study data in Germany

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