© 2002 by European Society of Cardiology
The application of a standardized strategy of evaluation in patients with syncope referred to three syncope units
1Department of Cardiology of Ospedali del Tigullio Lavagna, Italy; 2Department of Cardiology, Ospedale Civile Cento, Italy; 3Department of Cardiology, Ospedale S. Maria Nuova Reggio Emilia, Italy; 4Department of Cardiology, Ospedale Umberto I Mestre, Italy; 5Department of Cardiology, Ospedale S. Pietro I Fucecchio, Italy
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%), 
2 tests in 64 (21%) and 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.
Key Words: syncope, diagnosis, ambulatory ECG exercise test, electrophysiological study carotid sinus massage, tilt test, ATP test
Correspondence: Dr Francesco Croci, Dipartimento di Cardiologia, Ospedali Riuniti, Via Don Bobbio, Lavagna, Italy. Fax: +390185306506; E-mail: mbrignole{at}ASL4.liguria.it
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  Developed in collaboration with, European Heart Rhythm Association (EHRA), Heart Failure Association (HFA), and Heart Rhythm Society (HRS), Endorsed by the following societies, European Society of Emergency Medicine (EuSEM), European Federation of Internal Medicine (EFIM), European Union Geriatric Medicine Society (EUGMS), American Geriatrics Society (AGS), European Neurological Society (ENS), et al. Guidelines for the diagnosis and management of syncope (version 2009): The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC) Eur. Heart J., November 1, 2009; 30(21): 2631 - 2671. [Full Text] [PDF]
|
|
|
|
 |
|
 L. Y. Chen, D. G. Benditt, and W.-K. Shen Management of Syncope in Adults: An Update Mayo Clin. Proc., November 1, 2008; 83(11): 1280 - 1293. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Brignole, C. Menozzi, A. Bartoletti, F. Giada, A. Lagi, A. Ungar, I. Ponassi, C. Mussi, R. Maggi, G. Re, et al. A new management of syncope: prospective systematic guideline-based evaluation of patients referred urgently to general hospitals Eur. Heart J., January 1, 2006; 27(1): 76 - 82. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. K. Shen, W. W. Decker, P. A. Smars, D. G. Goyal, A. E. Walker, D. O. Hodge, J. M. Trusty, K. M. Brekke, A. Jahangir, P. A. Brady, et al. Syncope Evaluation in the Emergency Department Study (SEEDS): A Multidisciplinary Approach to Syncope Management Circulation, December 14, 2004; 110(24): 3636 - 3645. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Guidelines on Management (diagnosis and treatment) of syncope - update 2004: The Task Force on Syncope, European Society of Cardiology Europace, January 1, 2004; 6(6): 467 - 537. [Full Text] [PDF]
|
|
|
|
|
|
M. Disertori, M. Brignole, C. Menozzi, A. Raviele, P. Rizzon, M. Santini, A. Proclemer, C. Tomasi, A. Rossillo, F. Taddei, et al. Management of patients with syncope referred urgently to general hospitals Europace, January 1, 2003; 5(3): 283 - 291. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Brignole, M. Disertori, C. Menozzi, A. Raviele, P. Alboni, M. V. Pitzalis, P. Delise, E. Puggioni, M. Del Greco, V. Malavasi, et al. Management of syncope referred urgently to general hospitals with and without syncope units Europace, January 1, 2003; 5(3): 293 - 298. [Abstract] [Full Text] [PDF]
|
|