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Cited by 81Cardiovascular Syncope and Autonomic DisordersCardiovascular and Diving-Related ComplicationsCardiac Imaging and Diagnostics

Echocardiography in the evaluation of patients with syncope

Recchia, Dino, Barzilai, Benico·1995·Journal of General Internal Medicine
DOI 10.1007/bf02602755
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Abstract

Objective Echocardiography is frequently used as a screening test for cardiac disease in patients with syncope despite the lack of published data describing its utility in this regard. The goal of the study was to examine the frequency with which echocardiography was used in the evaluation of patients admitted to one medical center because of syncope and to examine the diagnostic information, over and above that provided by the initial history, physical examination, and electrocardiography, contributed by the echocardiogram.Design A retrospective review was performed of all patients admitted to the study institution because of syncope over a seven-month period.Setting University teaching hospital in an urban setting of 2.5 million population.Patients/participants One hundred twenty-eight patients were identified: 47 men and 81 women (average age 67 +/- 17 years). Patients for whom syncope was of a known cause, those with near-syncope or vertigo, those with clinically obvious seizure, or those referred for electrophysiologic testing were excluded, leaving 128 patients for analysis. Details from the admission history, physical examination, and electrocardiography for each patient were recorded. The results of all other diagnostic tests ordered to evaluate syncope were recorded along with any consultations obtained. The cause of syncope was assigned by examining all physicians' notes and test results and with the use of previously published diagnostic criteria as guidelines.Measurements and main results Ninety percent of the patients underwent cardiac testing other than routine electrocardiography and continuous telemetry monitoring while in the hospital. An echocardiogram was obtained for 64% of the patients and did not reveal an unsuspected cause for syncope in any case. The echocardiogram was normal for 52% of the patients undergoing the test. Echocardiograms of patients with syncope and no clinical evidence of heart disease by history, physical examination, or electrocardiography either were normal (63%) or provided no useful additional information for arriving at a diagnosis (37%). Nearly half (46%) of the patients undergoing echocardiography fit this clinical profile. Among the patients for whom cardiac disease was suspected after history, physical examination, or electrocardiography, the echocardiogram confirmed the suspected diagnosis for 48% and served to rule out a suspected diagnosis for the remaining 52%. In no instance did echocardiography provide an unsuspected cause for syncope. The history, physical examination, and initial electrocardiography provided sufficient information to permit a diagnosis to be made for 37 of the 48 patients (77%) for whom a cause of syncope was ultimately determined.Conclusion Echocardiography was frequently used in the evaluation of patients admitted to the hospital because of syncope of unclear cause. For patients without suspected cardiac disease after history, physical examination, and electrocardiography, the echocardiogram did not appear to provide additional useful information, suggesting that syncope alone may not be an indication for echocardiography. For patients with suspected heart disease, echocardiography served to confirm or refute the suspicious in equal proportions. These data provide an objective basis to prospectively define the optimal role of echocardiography in the evaluation of patients with syncope.

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Crossref · 10.1007/bf02602755

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  • For patients with suspected heart disease, echocardiography plays an important role in risk stratification.

    “and plays an important role in risk stratification. 235,236”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [235]

  • For patients with suspected heart disease, echocardiography serves to confirm or refute the suspicions in equal proportions.

    “For patients with suspected heart disease, echocardiography serves to confirm or refute the suspicions in equal proportions”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [235]

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Authors
Recchia, D., & Barzilai, B.
Affiliations
Washington University in St. Louis (US)
ORCID
Barzilai, Benico
Venue
Journal of General Internal Medicine
Publisher
Springer Science and Business Media LLC
Published
1995-12
Volume
10
Issue
12
Pages
649-655
ISSN
  • 0884-8734 (ISSN-L)
  • 1525-1497
DOI
10.1007/bf02602755
OpenAlex
W1967506798
Cited by
81
References
27
Citations by year
2026: 2 · 2024: 3 · 2022: 2 · 2021: 1 · 2020: 1 · 2019: 7 · 2018: 11 · 2017: 7 · 2016: 2 · 2015: 2 · 2014: 5 · 2013: 1 · 2012: 1
FWCI
1.26
Type
journal article
Language
en
Open access
closed
Licence
www.springer.com/tdm (tdm)
Locations
  • Journal of General Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cardiovascular and Diving-Related Complications
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
Keywords
syncope, echocardiography, cardiac screening, diagnostic yield, electrocardiogram, clinical history and physical examination, heart disease diagnosis, diagnostic testing utilization, hospitalization
MeSH terms
Adult, Aged, Aged, 80 and over, Echocardiography, Electrocardiography, Female, Humans, Male, Medical History Taking, Middle Aged, Physical Examination, Retrospective Studies, Syncope

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