RT Journal Article
SR Electronic
T1 Development of an electrocardiogram-based risk calculator for a cardiac cause of syncope
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 1796
OP 1804
DO 10.1136/heartjnl-2020-318430
VO 107
IS 22
A1 Tobias Zimmermann
A1 Jeanne du Fay de Lavallaz
A1 Joan Elias Walter
A1 Ivo Strebel
A1 Thomas Nestelberger
A1 Lydia Joray
A1 Patrick Badertscher
A1 Dayana Flores
A1 Velina Widmer
A1 Nicolas Geigy
A1 Oscar Miro
A1 Emilio Salgado
A1 Michael Christ
A1 Louise Cullen
A1 Martin Than
A1 Francisco Javier Martín-Sánchez
A1 Salvatore Di Somma
A1 W Frank Peacock
A1 Dagmar Keller
A1 Juan Pablo Costabel
A1 Desiree Nadine Wussler
A1 Damian Kawecki
A1 Jens Lohrmann
A1 Danielle Menosi Gualandro
A1 Michael Kuehne
A1 Tobias Reichlin
A1 Benjamin Sun
A1 Christian Mueller
A1 ,
YR 2021
UL http://heart.bmj.com/content/107/22/1796.abstract
AB Objective To develop an ECG-based tool for rapid risk assessment of a cardiac cause of syncope in patients ≥40 years.Methods In a prospective international multicentre study, 2007 patients ≥40 years presenting with syncope were recruited in the emergency department (ED) of participating centres ranging from large university hospitals to smaller rural hospitals in eight countries from May 2010 to July 2017. 12-Lead ECG recordings were obtained at ED presentation following the syncopal event. The primary diagnostic outcome, a cardiac cause of syncope, was centrally adjudicated by two independent cardiologists using all available clinical information including 12-month follow-up. ECG predictors for a cardiac cause of syncope were identified using penalised backward selection and a continuous-scale likelihood was calculated based on regression analysis coefficients. Findings were validated in an independent US multicentre cohort including 2269 patients.Results In the derivation cohort, a cardiac cause of syncope was adjudicated in 267 patients (16%). Seven ECG criteria were identified as predictors for this outcome: heart rate and QTc-interval (continuous predictors), rhythm, atrioventricular block, ST-segment depression, bundle branch block and ventricular extrasystole/non-sustained ventricular tachycardia (categorical predictors). Diagnostic accuracy of these combined predictors for a cardiac cause of syncope was high (area under the curve 0.80, 95% CI 0.77 to 0.83). Overall, 138 patients (8%) were rapidly triaged towards rule-out and 181 patients (11%) towards rule-in of a cardiac cause of syncope. External validation showed similar performance.Conclusion In patients ≥40 years with a syncopal event, a combination of seven ECG criteria enabled rapid assessment of the likelihood that syncope was due to a cardiac cause.Trial registration number NCT01548352 (BASEL IX), NCT01802398 (SRS study).No data are available. The data underlying this article cannot be shared publicly due to the lack of approval by the participating patients and institutions.