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Cited by 105Cardiovascular Syncope and Autonomic DisordersVestibular and auditory disordersHeart Rate Variability and Autonomic Control

The application of a standardized strategy of evaluation in patients with syncope referred to three syncope units

Open access
Croci, F·2002·Europace
DOI 10.1053/eupc.2002.0267
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Abstract

BACKGROUND: The appropriate diagnostic work-up of patients with syncope is not well defined. We applied the guidelines of Italian 'Associazione Nazionale Medici Cardiologi Ospedalieri' to a group of consecutive patients with syncope referred to three Syncope Units. The aim of the study was to evaluate the applicability of those guidelines in the 'real world' and their impact on the use of the tests. METHODS: We evaluated 308 consecutive patients with syncope (mean age 61 +/- 20 years; median of three syncopal episodes per patient). The hierarchy and appropriateness of diagnostic tests and the definitions of the final diagnosis followed standardized predefined criteria. In brief, all patients underwent initial evaluation consisting of history, physical examination, supine and upright blood pressure measurement and standard electrocardiogram (ECG) (only in patients > 45 years or with history of heart disease). Any subsequent investigations were based on the findings of the initial evaluation. Priority was given to cardiological tests (prolonged ECG monitoring, exercise test, electrophysiological study), or to neurally mediated tests (carotid sinus massage, tilt test, ATP test), or to neuro-psychiatric tests, as appropriate. FINDINGS: The initial evaluation alone was diagnostic in 72 patients (23%). One further test was necessary for diagnosis in 65 patients (21%), > or = 2 tests in 64 (21%) and > or = 3 tests in 50 (16%). The diagnostic yield was 10% for ECG, 3% for echocardiogram, 16% for Holter, 5% for exercise test, 27% for electrophysiological study, 57% for carotid sinus massage, 52% for tilt testing and 15% for ATP test. At the end of the work-up the mechanism of syncope remained unexplained in 57 patients (18%). CONCLUSIONS: When standardized criteria based on the appropriateness of indications are used, few simple tests are usually needed for diagnosis of syncope.

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  • The diagnostic yield of ECG monitoring varies from 1.9-17.6%.

    “Although the diagnostic yield of ECG monitoring varies from 1.9-17.6%, 158-160 it is justified by the need to avoid immediate risk to the patient.”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [160]

    The Discussion reports a 16% diagnostic yield for ECG monitoring, and Table 1 lists a 16% yield for Holter monitoring. That supports a value within the cited range, but this paper does not establish the stated 1.9–17.6% limits. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • Specialized syncope evaluation units may lead to reduced health service use and increased diagnostic rates.

    “Specialized syncope evaluation units may lead to reduced health service use and increased diagnostic rates (114–119).”

    From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [115]

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Research works printed but not linked: 2

  1. ANMCO Task Force. ANMCO Task Force Report: Orientamenti sulla valutazione diagnostica dei pazienti con sincope. G Ital Cardiol 1995; 25: 937-48.
  2. Linzer M, Yang E, Estes M, Wang P, Vorperian V, Kapoor W. Diagnosing syncope. Part II: Unexplained syncope. Ann Intern Med 1997; 127: 76-86.

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Authors
Croci, F.
Affiliations
Presidio Ospedaliero (IT)
Corresponding author
Croci, F
Venue
Europace
Publisher
Oxford University Press (OUP)
Published
2002-10
Volume
4
Issue
4
Pages
351-355
ISSN
1099-5129 (ISSN-L)
DOI
10.1053/eupc.2002.0267
OpenAlex
W2170822387
Cited by
105
References
19
Citations by year
2026: 2 · 2025: 1 · 2024: 2 · 2023: 1 · 2022: 5 · 2021: 1 · 2020: 3 · 2019: 2 · 2018: 4 · 2017: 18 · 2016: 4 · 2015: 5 · 2014: 7 · 2013: 10 · 2012: 3
FWCI
2.86
Type
journal article
Language
en
Open access
Locations
  • EP Europace (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
  • Life Sciences › Neuroscience › Neurology › Vestibular and auditory disorders
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
Keywords
syncope, diagnostic workup, syncope unit, diagnostic yield, tilt table test, carotid sinus massage, electrophysiological study, exercise testing, neurally mediated syncope, unexplained syncope
MeSH terms
Adult, Aged, Aged, 80 and over, Algorithms, Female, Humans, Male, Middle Aged, Physical Examination, Syncope, Electrocardiography, Ambulatory, Practice Guidelines as Topic

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