Things We Do For No Reason: Echocardiogram in Unselected Patients with Syncope

Area of Science:

• Cardiology
• Diagnostic Imaging

Background:

• Syncope is a frequent reason for emergency department visits and hospitalizations.
• Echocardiograms are commonly performed in syncope evaluations, with rates ranging from 39% to 91%.

Purpose of the Study:

• To evaluate the diagnostic utility of echocardiograms in syncope patients.
• To assess the impact of recent guideline changes on echocardiogram use in syncope management.

Main Methods:

• Review of diagnostic yield of echocardiograms in syncope patients based on clinical presentation and initial testing.
• Analysis of current guidelines for echocardiogram use in syncope.

Main Results:

• Echocardiograms have a very low diagnostic yield for clinically significant abnormalities in syncope patients with normal history, physical exam, and ECG.
• In patients with concerning cardiac history, abnormal exam, or abnormal ECG, echocardiograms identify abnormalities in up to 29% of cases, though causality is not always clear.
• Recent guidelines recommend echocardiogram only when cardiac etiology is suspected or ECG is abnormal.

Conclusions:

• Routine echocardiography in all syncope patients leads to unnecessary testing and costs.
• Targeted echocardiogram use based on clinical suspicion and initial findings aligns with evidence-based, high-value care for syncope.