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Syncope Predicts the Outcome of Cardiomyopathy Patients
Open accessAbstract
Objectives The outcome of congestive heart failure (CHF) patients with syncope is understood incompletely.Background We analyzed data from patients enrolled in the SCD-HeFT (Sudden Cardiac Death Heart Failure Trial) to determine whether syncope predicted outcomes in patients with CHF.Methods We compared outcomes (and associated clinical characteristics) in patients with and without syncope enrolled in SCD-HeFT.Results In SCD-HeFT, 162 (6%) patients had syncope before randomization, 356 (14%) had syncope after randomization (similar incidence in each randomized arm), and 46 (2%) had syncope before and after randomization. A QRS duration >or=120 ms and absence of beta-blocker use predicted syncope during follow-up (hazard ratio [HR] 1.30 and 95% confidence interval [CI] 1.06 to 1.61, p = 0.014 and HR 1.25, 95% CI 1.01 to 1.56, p = 0.048, respectively). Syncope recurrence did not differ by randomization arm. However, in the implantable cardioverter-defibrillator (ICD) arm, syncope, before and after randomization, was associated with appropriate ICD discharges (HR 1.75, 95% CI 1.10 to 2.80, p = 0.019 and HR 2.91, 95% CI 1.89 to 4.47, p = 0.001, respectively). Post-randomization syncope predicted total and cardiovascular death (HR 1.41, 95% CI 1.13 to 1.76, p = 0.002 and HR 1.55, 95% CI 1.19 to 2.02, p = 0.001, respectively). The elevated relative risk of mortality for syncope versus non-syncope patients did not vary significantly across treatment arms (ICD, HR 1.54, 95% CI 1.04 to 2.27; amiodarone, HR 1.33, 95% CI 0.91 to 1.93; and placebo, HR 1.39, 95% CI 0.96 to 2.02, test for difference p = 0.86).Conclusions For CHF patients with ICDs, syncope was associated with appropriate ICD activations. Syncope was associated with increased mortality risk in SCD-HeFT regardless of treatment arm (placebo, amiodarone, or ICD).
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“Although ICD may not prevent syncope recurrence in these patients, 31,348 it is indicated to reduce the risk of SCD”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [31]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“When indicated, ICD prevents SCD but it may be unable to prevent syncope due to VT recurrence. 31,348”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [31]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“In patients with New York Heart Association class III–IV HF, syncope is present in 12% to 14% of patients (46,47).”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [46]
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In the citing paper
“Structural heart disease 25-27,31,35,36,45 and primary electrical disease 46 are major risk factors for sudden cardiac death (SCD) and overall mortality in patients with syncope.”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [31]
The check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Arrhythmic syncope is highly probable when the ECG shows 25-39 : • Persistent sinus bradycardia <40 b.p.m. or sinus pauses >3 s in awake state and in absence of physical training; • Mobitz II second- and third-degree AV block; • Alternating left and right BBB; • VT or rapid paroxysmal SVT;”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [31]
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“Cardiac ischaemia-related syncope is confirmed when syncope presents with evidence of acute myocardial ischaemia with or without myocardial infarction. 25-39”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [31]
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Metadata
- Authors
- Olshansky, B., Poole, J. E., Johnson, G., Anderson, J., Hellkamp, A. S., Packer, D., Mark, D. B., Lee, K. L., & Bardy, G. H.
- Affiliations
- University of Iowa (US)
- University of Washington (US)
- The Seattle Institute for Cardiac Research (US)
- Duke University (US)
- Mayo Clinic (US)
- Corresponding author
- Olshansky, Brian
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2008-04
- Volume
- 51
- Issue
- 13
- Pages
- 1277-1282
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2135351378
- Cited by
- 119
- References
- 32
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 1 · 2023: 3 · 2022: 2 · 2021: 3 · 2020: 5 · 2019: 1 · 2018: 11 · 2017: 20 · 2016: 2 · 2015: 9 · 2014: 7 · 2013: 14 · 2012: 8
- FWCI
- 10.19
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- Medtronic
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Keywords
- syncope, congestive heart failure, cardiomyopathy, SCD-HeFT trial, implantable cardioverter-defibrillator, mortality prediction, QRS duration, beta-blocker therapy, amiodarone, sudden cardiac death, syncope recurrence, prognostic factors, cardiovascular mortality, arrhythmic risk stratification, heart failure with reduced ejection fraction
- MeSH terms
- Adult, Amiodarone, Anti-Arrhythmia Agents, Female, Health Status, Heart Failure, Humans, Male, Middle Aged, Cardiomyopathies, Predictive Value of Tests, Prognosis, Recurrence, Risk, Risk Factors, Stroke Volume, Syncope, Time Factors, Death, Sudden, Cardiac, Treatment Outcome, Defibrillators, Implantable, Myocardial Ischemia
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