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The role of echocardiography in diagnostic evaluation of patients with syncope-a retrospective analysis
Ali Raza Ghani1, Waqas Ullah1, Hafez Mohammad Ammar Abdullah2
1Internal Medicine, Abington-Jefferson Health Abington, PA, USA.
Insights
Echocardiography is less beneficial for syncope patients with normal exams and EKGs. Focus on high-risk syncope patients for better diagnostic yield and resource allocation.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Clinical Medicine
Background:
- Syncope involves transient loss of consciousness due to reduced cerebral blood flow.
- 2D-transthoracic echocardiography (TTE) identifies structural heart disease causing syncope, such as aortic stenosis or atrial masses.
- Identifying syncope subgroups most benefiting from TTE is crucial for efficient diagnosis.
Purpose of the Study:
- To determine which syncope patient subgroups gain the most diagnostic value from 2D-transthoracic echocardiography (TTE).
- To assess the utility of TTE in patients with syncope based on physical examination and EKG findings.
Main Methods:
- Retrospective chart review of adult syncope patients admitted between January 2015 and January 2017.
- Analysis of echocardiographic findings in relation to patient demographics, physical exam, and EKG results.
- Inclusion criteria applied to 369 initial patients, with 139 in the final analysis.
Main Results:
- 43.75% of high-risk syncope patients (abnormal exam/EKG) showed significant echocardiographic findings.
- Only 10% of low-risk syncope patients (normal exam/EKG) had significant echocardiographic findings.
- Abnormal EKG or physical exam findings increased the likelihood of an abnormal echocardiogram by 7.08 times (P < 0.001).
Conclusions:
- The diagnostic yield of 2D-TTE is limited in syncope patients with normal physical exams and EKGs.
- Routine TTE in low-risk syncope patients may unnecessarily burden healthcare resources and finances.
- TTE is most valuable in syncope patients with concerning clinical or electrocardiographic findings.
Background:
Syncope is a symptom complex comprising of a brief loss of consciousness leading to a transient decrease in cerebral blood flow that resolves completely. 2D-transthoracic echocardiography (TTE) is a useful tool to detect underlying structural heart disease, which can lead to syncope, e.g., aortic stenosis, atrial masses. This study aimed to find the subgroups of patients with syncope who would benefit the most from a TEE.
Methods:
We did a retrospective chart review of all patients aged 18 years or older, admitted to our hospital with a primary diagnosis of syncope between January 2015 and January 2017 to determine the frequency and findings of echo in all these patients. The baseline characteristics, demographics were taken into account for the inclusion of these patients into the study.
Results:
A total of 369 patients were initially studied, but only 139 patients were included in the final analysis based on inclusion criteria. Among the high-risk patients (i.e., abnormal Physical exam and/or abnormal EKG, population), 43.75% had significant echocardiographic finding. While among low-risk patients (i.e., normal EKG and exam), 10% (9/91) had a significant finding. Patients with abnormal EKG or examination findings were 7.08 times (95% CI = 2.89-17.3) more likely to have an abnormal echocardiogram (P < 0.001).
Conclusion:
Our study suggests that the diagnostic yield of 2D-TTE in the absence of abnormal physical exam and/or abnormal EKG is very limited and may add an extra burden on the finances and resources of both the patient and the hospital.
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