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Prognostic Value of Stress Echocardiography in Patients Presenting with Syncope
Jose Ricardo F Po1, Farooq A Chaudhry1, Kiruthika Balasundaram1
1Mount Sinai St. Luke's and Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York.
Insights
High-risk patients with syncope face greater ischemia and mortality risk. Stress echocardiography identifies these patients, but ischemia presence may not predict long-term outcomes.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Clinical Prognosis
Background:
- Syncope evaluation is crucial for patients with coronary artery disease risk factors.
- Stress echocardiography is a key diagnostic tool in cardiology.
- Determining prognostic indicators for syncope is essential.
Purpose of the Study:
- To assess the prognostic value of stress echocardiography in syncope patients.
- To identify risk factors for adverse outcomes in syncope presentations.
- To evaluate the predictive power of ischemia on long-term mortality.
Main Methods:
- Retrospective analysis of patients undergoing stress echocardiography.
- Stratification into high-risk and low-risk groups based on established criteria.
- Assessment of ischemia on imaging and all-cause mortality via the Social Security Death Index.
Main Results:
- The high-risk group (62 patients) showed significantly higher rates of ischemia (16%) compared to the low-risk group (3%).
- All-cause mortality was substantially greater in the high-risk group (3.99%/year) versus the low-risk group (1.02%/year).
- Ischemia detection did not significantly alter the observed mortality difference between risk groups.
Conclusions:
- Patients with syncope and high-risk features have an elevated risk of ischemia and mortality.
- Stress echocardiography effectively identifies high-risk syncope patients.
- Ischemia's predictive value for long-term outcomes in this cohort requires further investigation.
Background:
Evaluation for ischemia is appropriate in patients at risk for or with a history of coronary artery disease presenting with syncope. The aim of this study is to determine the prognostic value of stress echocardiography in patients presenting with syncope.
Methods:
We examined our database of all patients undergoing stress echocardiography at our institution. Patients referred due to syncope were grouped as high risk based on any of the following: (1) known history of coronary artery disease, (2) left ventricular ejection fraction <50%, (3) moderate or severe mitral or aortic valve regurgitation, and (4) moderate mitral or aortic valve stenosis. The main outcomes were the presence of ischemia on stress imaging and all-cause mortality using the social security death index.
Results:
A total of 225 patients were identified; mean age was 64.3 ± 14.5 years, the mean follow-up duration was 29.2 ± 13.8 months. There were 163 patients in the low-risk group and 62 patients in the high-risk group. On imaging, 7% of the overall cohort had ischemia. The low-risk group had 5 (3%) patients with ischemia and the high-risk group had 10 patients (16%) with ischemia (P < 0.01). The mortality rate was significantly higher in the high-risk group (3.99%/year vs. 1.02%/year; P = 0.02); this difference was not affected by the presence of ischemia.
Conclusions:
High-risk patients with syncope as defined by appropriateness criteria and existing evidence carry a higher risk of ischemia and all-cause mortality. The presence of ischemia may not be predictive of long-term outcome in this group.
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