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Updated: May 30, 2026
Quantitative Autonomic Testing
Published on: July 19, 2011
Clinical history in the diagnosis of the cardiac syncope–the predictive scoring system
Peter Mitro1, Peter Kirsch, Gabriel Valočik
1Clinic of Internal Medicine III, University Hospital, PJ Safarik University, Kosice, Slovakia. peter.mitro@upjs.sk
Insights
A new diagnostic scoring system aids in distinguishing cardiac from noncardiac syncope using clinical history. This tool helps identify serious cardiac causes of syncope for better patient outcomes.
Area of Science:
- Cardiology
- Clinical Diagnostics
Background:
- Cardiac syncope is a serious condition with a poor prognosis.
- Differentiating cardiac from noncardiac syncope is crucial for appropriate management.
Purpose of the Study:
- To develop a diagnostic scoring system based on clinical history.
- To differentiate between cardiac and noncardiac syncope.
Main Methods:
- A structured questionnaire collected clinical history from 60 cardiac syncope and 140 noncardiac syncope patients.
- Multivariate regression analysis identified key predictive variables for the scoring system.
Main Results:
- Key predictors for cardiac syncope included age >55, structural heart disease, supine syncope, absence of prodrome, and chest pain.
- Predictors for noncardiac syncope included recovery >1 minute and syncope after standing.
- The derived score showed 81% sensitivity and 84.8% specificity in a validation group.
Conclusions:
- A predictive model using clinical history parameters can effectively distinguish cardiac from other causes of syncope.
- This scoring system offers a valuable tool for clinical decision-making in syncope evaluation.
Background:
Cardiac syncope represents clinical situation with serious prognosis. The aim of the present study was to develop the diagnostic scoring system based on the clinical history allowing to distinguish between cardiac and noncardiac syncope.
Methods:
Clinical history was obtained in the form of the structured questionnaire in 60 patients with cardiac syncope (mean age 70 ± 10 years, 33 men) an in 140 patients with noncardiac syncope (mean age 45 ± 20 years, 44 men). Multivariate regression analysis identified seven variables that were included in the final regression model.
Results:
The age above 55 years, presence of structural heart disease, syncope in supine position, absence of prodromal symptoms, and chest pain before syncope were predictive of cardiac syncope. Predictors of noncardiac syncope were recovery duration of more than 1 minute and syncope occurring immediately after standing up. A diagnostic point score was derived from the regression coefficients. The sum of the points identified patients with cardiac syncope if the diagnostic point score was ≤2. Diagnostic performance of the score was assessed on the validation group of 67 patients with syncope (21 patients with cardiac syncope and 46 patients with noncardiac syncope). Sensitivity was 81%, specificity 84.8%, positive predictive value 70.8%, and negative predictive value 90.7%.
Conclusion:
Predictive model based on parameters form clinical history of the patients may help to distinguish between cardiac and other causes of syncope.
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