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Current Problems in Cardiology Jan 2024This review looks into the use of Artificial Intelligence (AI) in the management of syncope, a condition characterized by a brief loss of consciousness caused by... (Review)
Review
This review looks into the use of Artificial Intelligence (AI) in the management of syncope, a condition characterized by a brief loss of consciousness caused by cerebral hypoperfusion. With rising prevalence, high costs, and difficulty in diagnosis and risk stratification, syncope poses significant healthcare challenges. AI has the potential to improve symptom differentiation, risk assessment, and patient management. Machine learning, specifically Artificial Neural Networks, has shown promise in accurate risk stratification. AI-powered clinical decision support tools can improve patient evaluation and resource utilization. While AI holds great promise for syncope management, challenges such as data quality, class imbalance, and defining risk categories remain. Ethical concerns about patient privacy, as well as the need for human empathy, complicate AI integration. Collaboration among data scientists, clinicians, and ethics experts is critical for the successful implementation of AI, which has the potential to improve patient outcomes and healthcare efficiency in syncope management.
Topics: Humans; Artificial Intelligence; Risk Assessment; Syncope
PubMed: 37716544
DOI: 10.1016/j.cpcardiol.2023.102079 -
Europace : European Pacing,... Mar 2023There is little evidence of the impact of syncope in implantable cardioverter-defibrillator (ICD) patients in routine community hospital care. This single-centre...
AIMS
There is little evidence of the impact of syncope in implantable cardioverter-defibrillator (ICD) patients in routine community hospital care. This single-centre retrospective study sought to evaluate the incidence and prognostic significance of syncope in consecutive ICD patients.
METHODS AND RESULTS
Data were collected on consecutive patients undergoing first ICD implantation between January 2009 and December 2019. The primary endpoints were the first occurrence of all-cause syncope, all-cause mortality, and all-cause hospitalization. Multivariate Cox proportional hazard models were used to identify risk factors associated with syncope and to analyse the subsequent risk of mortality and hospitalization. 1003 patients (58% primary prevention) were included in the final analysis. During a mean follow-up of 1519 ± 1055 days, 106 (10.6%) experienced syncope, 304 died (30.3%), and 477 (47.5%) were hospitalized for any cause. In an analysis adjusted for baseline variables, the first occurrence of syncope was associated with a significantly increased risk of mortality (HR 2.82, P < 0.001) and the first occurrence of hospitalization (HR 2.46, P = 0.002).
CONCLUSION
Syncope in ICD recipients is common and associated with a poor prognosis irrespective of baseline variables and ICD programming. The occurrence of syncope is associated with a significant increase in the risk of mortality and hospitalization.
Topics: Humans; Retrospective Studies; Defibrillators, Implantable; Prognosis; Risk Factors; Syncope
PubMed: 36638366
DOI: 10.1093/europace/euac281 -
Arquivos Brasileiros de Cardiologia Jul 2018Carotid sinus hypersensitivity (CSH) is a frequent finding in the evaluation of syncope. However, its significance in the clinical setting is still dubious. A new...
BACKGROUND
Carotid sinus hypersensitivity (CSH) is a frequent finding in the evaluation of syncope. However, its significance in the clinical setting is still dubious. A new criterion was proposed by Solari et al. with a symptomatic systolic blood pressure (SBP) cut-off value of ≤ 85 mmHg to refine the vasodepressor (VD) response diagnosis.
OBJECTIVE
To determine and compare the response to carotid sinus massage (CSM) in patients with and without syncope according to standard and proposed criteria.
METHODS
CSM was performed in 99 patients with and 66 patients without syncope. CSH was defined as cardioinhibitory (CI) for asystole ≥ 3 seconds, or as VD for SBP decrease ≥ 50 mmHg.
RESULTS
No differences in the hemodynamic responses were observed during CSM between the groups, with 24.2% and 25.8% CI, and 8.1% and 13.6% VD in the symptomatic and asymptomatic groups, respectively (p = 0.466). A p value < 0.050 was considered statistically significant. During the maneuvers, 45 (45.45%) and 34 (51.5%) patients in the symptomatic and asymptomatic groups achieved SBP below ≤ 85 mmHg. Symptoms were reported especially in those patients in whom CSM caused a SBP decrease to below 90 mmHg and/or asystole > 2.5 seconds, regardless of the pattern of response or the presence of previous syncope.
CONCLUSION
The response to CSM in patients with and without syncope was similar; therefore, CSH may be an unspecific condition. Clinical correlation and other methods of evaluation, such as long-lasting ECG monitoring, may be necessary to confirm CSH as the cause of syncope.
Topics: Carotid Sinus; Humans; Syncope
PubMed: 30110049
DOI: 10.5935/abc.20180114 -
Indian Pediatrics Feb 2021To describe the clinical profile of children with syncope.
OBJECTIVE
To describe the clinical profile of children with syncope.
METHODS
Hospital records were reviewed for clinical and laboratory details of children presenting with real or apparent syncope. Five diagnostic categories were identified: neurocardiogenic syncope (NCS), psychogenic pseudosyncope (PPS), cardiac, neurological and indeterminate.
RESULTS
30 children (aged 4 to 17 years)were included. The commonest cause of syncope was NCS (63.3%), followed by PPS (13.3%), cardiac (10%), neurological (10%) and indeterminate (3.3%). Exercise, loud noise or emotional triggers and family history were associated with cardiac etiology, and electrocardiogram (ECG) was diagnostic in the majority. Children with PPS and cardiacsyncope had frequent episodes when compared with other groups. Indiscriminate antiepileptic use was found in 5 children, including two cardiac cases.
CONCLUSIONS
Frequent recurrences of syncope may suggest PPS or cardiac cause. Cardiac etiology may be readily identified on history and ECG alone.
Topics: Child; Electrocardiography; Humans; Recurrence; Syncope
PubMed: 33632942
DOI: No ID Found -
Clinical Cardiology Jul 2023Vasovagal syncope (VVS) is the most prevalent type of syncope and its management includes pharmacologic and non-pharmacologic interventions. Recently, studies have... (Meta-Analysis)
Meta-Analysis Review
Vasovagal syncope (VVS) is the most prevalent type of syncope and its management includes pharmacologic and non-pharmacologic interventions. Recently, studies have investigated vitamin D levels in VVS patients. In this systematic review and meta-analysis, we aim to review these studies to find possible associations between vitamin D deficiency and vitamin D levels with VVS. International databases including Scopus, Web of Science, PubMed, and Embase were searched with keywords related to "vasovagal syncope" and "vitamin D." Studies were screened and the data were extracted from them. Random-effect meta-analysis was conducted to calculate the standardized mean difference (SMD) and 95% confidence interval (CI) for vitamin D levels in comparison to VVS patients and controls. Also, VVS occurrence was measured and the odds ratio (OR) and 95% CI were calculated for comparison of vitamin D deficient cases and nondeficient individuals. Six studies were included with 954 cases investigated. Meta-analysis showed that patients with VVS had significantly lower vitamin D serum levels in comparison to non-VVS cases (SMD -1.05, 95% CI -1.54 to -0.57, p-value < .01). Moreover, VVS occurrence was higher in vitamin D-deficient individuals (OR 5.43, 95% CI 2.40 to 12.27, p-value < .01). Our findings which show lower vitamin D levels in VVS patients can have clinical implications in order for clinicians to pay attention to this when approaching VVS. Further randomized controlled trials are certainly warranted to assess the role of vitamin D supplementation in individuals with VVS.
Topics: Humans; Tilt-Table Test; Syncope, Vasovagal; Syncope; Vitamin D Deficiency; Vitamin D
PubMed: 37226313
DOI: 10.1002/clc.24035 -
Turk Kardiyoloji Dernegi Arsivi : Turk... Sep 2017Elderly syncope currently accounts a substantial number of emergency admissions. Unfortunately, in elderly syncope we are faced with major difficulties while providing...
Elderly syncope currently accounts a substantial number of emergency admissions. Unfortunately, in elderly syncope we are faced with major difficulties while providing diagnostic and therapeutic decisions. It is quite necessary to distinguish between syncope and non-syncopal causes which create further difficulties during diagnostic work-up because of co-morbid conditions and poly-pharmacy used by the elderly. The present article aims to describe causes of elderly syncope and its differential diagnosis as well as tips and tricks during diagnostic process.
Topics: Aged; Aged, 80 and over; Comorbidity; Diagnosis, Differential; Humans; Syncope
PubMed: 28976385
DOI: 10.5543/tkda.2017.00180 -
Journal of the American Heart... Sep 2018Background Syncope accounts for 0.6% to 1.5% of hospitalizations in the United States. We sought to determine the causes and predictors of 30-day readmission in patients... (Observational Study)
Observational Study
Background Syncope accounts for 0.6% to 1.5% of hospitalizations in the United States. We sought to determine the causes and predictors of 30-day readmission in patients with syncope. Methods and Results We identified 323 250 encounters with a primary diagnosis of syncope/collapse in the 2013-2014 Nationwide Readmissions Database. We excluded patients younger than 18 years, those discharged in December, those who died during hospitalization, hospital transfers, and those whose length of stay was missing. We used multivariable logistic regression analysis to evaluate the association between baseline characteristics and 30-day readmission. A total of 282 311 syncope admissions were included. The median age was 72 years (interquartile range, 58-83), 53.9% were women, and 9.3% had 30-day readmission. The most common cause of 30-day readmissions was syncope/collapse, followed by cardiac, neurological, and infectious causes. Characteristics associated with 30-day readmissions were age 65 years and older (odds ratio [OR], 0.7; 95% confidence interval [ CI ], 0.6-0.7), female sex (OR, 0.9; 95% CI, 0.8-0.9), congestive heart failure (OR, 1.5; 95% CI, 1.2-1.9), atrial fibrillation/flutter (OR, 1.3; 95% CI, 1.3-1.4), diabetes mellitus (OR, 1.2; 95% CI, 1.2-1.3), coronary artery disease (OR, 1.2; 95% CI, 1.2-1.3), anemia (OR, 1.4; 95% CI, 1.4-1.5), chronic obstructive pulmonary disease (OR, 1.4; 95% CI, 1.3-1.4), home with home healthcare disposition (OR, 1.5; 95% CI, 1.5-1.6), leaving against medical advice (OR, 1.7; 95% CI, 1.6-1.9), length of stay of 3 to 5 days (OR, 1.5; 95% CI, 1.4-1.6) or >5 days (OR, 2; 95% CI, 1.8-2), and having private insurance (OR, 0.6; 95% CI, 0.6-0.7). Conclusions The 30-day readmission rate after syncope/collapse was 9.3%. We identified causes and risk factors associated with readmission. Future prospective studies are needed to derive risk-stratification models to reduce the high burden of readmissions.
Topics: Aged; Aged, 80 and over; Female; Follow-Up Studies; Humans; Incidence; Male; Middle Aged; Patient Discharge; Patient Readmission; Population Surveillance; Prognosis; Retrospective Studies; Risk Factors; Syncope; Time Factors; United States
PubMed: 30371179
DOI: 10.1161/JAHA.118.009746 -
Revista Portuguesa de Cardiologia :... 2016Syncope is a common but concerning event in young athletes. Although mostly due to benign reflex causes, syncope may be arrhythmic and precede sudden cardiac death.... (Review)
Review
Syncope is a common but concerning event in young athletes. Although mostly due to benign reflex causes, syncope may be arrhythmic and precede sudden cardiac death. Efforts must therefore be made to distinguish post-exertional syncope from syncope during exercise, which can be an ominous sign of a possible underlying heart disease, such as hypertrophic cardiomyopathy. Prevention requires cooperation between physician and athlete, in order to identify individuals at risk and to protect them from sudden death. Solving this diagnostic dilemma may lead to recommendations for athletes to be cleared to play or disqualified from competitive sports, and presents challenging and controversial decisions to the health care provider that can prove difficult to implement. Although exercise contributes to physical and psychological well-being, there are insufficient data to indicate whether an athlete with hypertrophic cardiomyopathy diagnosed after a syncopal episode can safely resume competitive physical activity. The purpose of this study was to review the literature on syncope in young athletes and its relationship to individuals with hypertrophic cardiomyopathy, in order to enable accurate assessment of prognosis and the possibility of resuming competitive sports.
Topics: Athletes; Cardiomyopathy, Hypertrophic; Death, Sudden, Cardiac; Exercise; Humans; Prognosis; Sports; Syncope; Young Adult
PubMed: 27372256
DOI: 10.1016/j.repc.2016.04.007 -
The Journal of Invasive Cardiology Oct 2023A 69-year-old obese man who had undergone permanent pacemaker implantation (VVIR, Medtronic) 3 weeks prior presented with a one-day history of experiencing continued,...
A 69-year-old obese man who had undergone permanent pacemaker implantation (VVIR, Medtronic) 3 weeks prior presented with a one-day history of experiencing continued, forceful pulsations in his abdomen followed by presyncope.
Topics: Male; Humans; Aged; Pacemaker, Artificial; Abdomen; Syncope; Equipment Design
PubMed: 37984332
DOI: 10.25270/jic/23.00210 -
BMJ Open Respiratory Research Apr 2023The incidence of the signs and symptoms of acute pulmonary embolism (PE) according to mortality risk, age and sex has been partly explored.
Signs and symptoms of acute pulmonary embolism and their predictive value for all-cause hospital death in respect of severity of the disease, age, sex and body mass index: retrospective analysis of the Regional PE Registry (REPER).
BACKGROUND
The incidence of the signs and symptoms of acute pulmonary embolism (PE) according to mortality risk, age and sex has been partly explored.
PATIENTS AND METHODS
A total of 1242 patients diagnosed with acute PE and included in the Regional Pulmonary Embolism Registry were enrolled in the study. Patients were classified as low risk, intermediate risk or high risk according to the European Society of Cardiology mortality risk model. The incidence of the signs and symptoms of acute PE at presentation with respect to sex, age, and PE severity was investigated.
RESULTS
The incidence of haemoptysis was higher in younger men with intermediate-risk (11.7% vs 7.5% vs 5.9% vs 2.3%; p=0.01) and high-risk PE (13.8% vs 2.5% vs 0.0% vs 3.1%; p=0.031) than in older men and women. The frequency of symptomatic deep vein thrombosis was not significantly different between subgroups. Older women with low-risk PE presented with chest pain less commonly (35.8% vs 55.8% vs 48.8% vs 51.9%, respectively; p=0.023) than men and younger women. However, younger women had a higher incidence of chest pain in the lower-risk PE group than in the intermediate-risk and high-risk PE subgroups (51.9%, 31.4% and 27.8%, respectively; p=0.001). The incidence of dyspnoea (except in older men), syncope and tachycardia increased with the risk of PE in all subgroups (p<0.01). In the low-risk PE group, syncope was present more often in older men and women than in younger patients (15.5% vs 11.3% vs 4.5% vs 4.5%; p=0.009). The incidence of pneumonia was higher in younger men with low-risk PE (31.8% vs<16% in the other subgroups, p<0.001).
CONCLUSION
Haemoptysis and pneumonia are prominent features of acute PE in younger men, whereas older patients more frequently have syncope with low-risk PE. Dyspnoea, syncope and tachycardia are symptoms of high-risk PE irrespective of sex and age.
Topics: Male; Humans; Female; Aged; Retrospective Studies; Hemoptysis; Body Mass Index; Prognosis; Pulmonary Embolism; Syncope; Registries; Chest Pain; Hospitals
PubMed: 37076250
DOI: 10.1136/bmjresp-2022-001559