Echocardiography in the diagnostic evaluation of syncope

To assess the role of echocardiography in patients with syncope, we studied 439 consecutive adults who were referred over a 7-year period. Of all patients, 251 (57.2%) were women, who were generally younger than male referrals. All 439 patients had interpretable echocardiographic studies. Results showed that of patients younger than 40 years of age, 72.8% had scans that were normal and 18.5% had mitral valve prolapse (MVP). All (other) patients in this age group with abnormal echocardiographic findings (8.7%) had either abnormal physical findings over the heart, an abnormal electrocardiogram, or an abnormal chest radiograph. In patients 60 years old and older, 29.6% had scans interpreted as normal and 4.6% had MVP (approximately half of these patients had at least moderate mitral regurgitation). The study demonstrates that patients younger than 40 years of age with syncope are likely to have a normal Doppler echocardiography or MVP without significant mitral regurgitation. Thus additional abnormal findings (e.g., heart murmur, abnormal electrocardiogram, or abnormal chest radiograph) may be needed before the patient is referred to the echocardiography laboratory.