Cardiogenic vertigo: clinical characteristics and predictors of long-term prognosis

To elucidate the clinical characteristics and long-term prognosis of cardiogenic vertigo (CV).

We retrospectively analyzed the clinical characteristics and predictors of long-term outcomes in 82 patients (age range 36-91 years, 72 ± 9.4 years) with CV over a 10-year period at four university hospitals in Korea. All patients underwent both comprehensive vestibular and systematic cardiac evaluation. The follow-up period ranged from 3 to 161 months (median, 41.8 months). Patients received procedural interventions (n = 51, 62%) or medical treatment (n = 31, 38%). Outcomes were analyzed using multivariable logistic regression and Kaplan-Meier survival analysis.

Recurrent vertigo occurred without syncope in 48% of patients and in relation to syncope in the remainder. Episodes were typically brief (seconds in 84%, minutes in 16%) and were accompanied by additional symptoms in 95%. Male sex was more prevalent in the syncope group (p = 0.023), whereas vertigo was more frequent in the non-syncope group (p < 0.05). Sick sinus syndrome predominated in the non-syncope group (p = 0.012), while complete atrioventricular block was observed exclusively in the syncope group (14%). During follow-up, 11 deaths (15%) and 10 vertigo recurrence (13%) were recorded. Male sex is the only independent predictor of mortality (adjusted odds ratio 7.02, p = 0.018), and procedural interventions were associated with lower vertigo recurrence compared with medical treatment alone (p = 0.022).

Cardiovascular disorders may present as recurrent isolated vertigo, with or without syncope. Distinct clinical features can aid in differentiating CV from other vestibular disorders. Male sex appears to be an independent predictor of mortality, and active cardiac intervention reduce vertigo recurrence and improve clinical outcomes.