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Available online 28 December 2021
Long-term recurrences and mortality in patients with noncardiac syncope
Recurrencia y mortalidad a largo plazo de los pacientes con síncope no cardiogénico
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Gonzalo Barón-Esquiviasa,b,c,
Corresponding author
gonzalo.baron.sspa@juntadeandalucia.es

Corresponding author: Avda. de Portugal 19, 41004 Seville, Spain.
, Macarena Quintanillaa, Antonio J. Díaz-Martína, Carmen Barón-Solísa, Carmen V. Almeida-Gonzálezd, Carmen García-Romeroa, Inmaculada Panequea, Carmen Rubio-Guerreroa, Rosario Rodríguez-Corredora, Juan I. Valle-Raceroa, Antonio Ordóñeza,b,c, Carlos A. Morilloe
a Servicio de Cardiología y Cirugía Cardiaca, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Seville, Spain
b Unidad Cardiovascular, Instituto de Biotecnología de Sevilla (IBIS), Seville, Spain
c Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
d Unidad de Metodología, Estadística e Investigación, Instituto de Biotecnología de Sevilla (IBIS), Seville, Spain
e Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
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Tables (3)
Table 1. Clinical characteristics of the 589 patients by sex, final etiological diagnosis, recurrence, and mortality.
Table 2. Causes of death in the study population
Table 3. Clinical characteristics according to mortality during follow-up. Univariate and multivariate analysis between characteristics and mortality
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Additional material (1)
Abstract
Introduction and objectives

There are no in-depth studies of the long-term outcome of patients with syncope after exclusion of cardiac etiology. We therefore analyzed the long-term outcome of this population.

Methods

For 147 months, we included all patients with syncope referred to our syncope unit after exclusion of a cardiac cause.

Results

We included 589 consecutive patients. There were 313 (53.1%) women, and the median age was 52 [34-66] years. Of these, 405 (68.8%) were diagnosed with vasovagal syncope (VVS), 65 (11%) with orthostatic hypotension syncope (OHS), and 119 (20.2%) with syncope of unknown etiology (SUE). During a median follow-up of 52 [28-89] months, 220 (37.4%) had recurrences (21.7% ≥ 2 recurrences), and 39 died (6.6%). Syncope recurred in 41% of patients with VVS, 35.4% with OHS, and 25.2% with SUE (P=.006). In the Cox multivariate analysis, recurrence was correlated with age (P=.002), female sex (P <.0001), and the number of previous episodes (< 5 vs ≥ 5; P <.0001). Death occurred in 15 (3.5%) patients with VVS, 11 (16.9%) with OHS, and 13 (10.9%) with SUE (P=.001). In the multivariate analysis, death was associated with age (P=.0001), diabetes (P=.007), and diagnosis of OHS (P=.026) and SUE (P=.020).

Conclusions

In patients with noncardiac syncope, the recurrence rate after 52 months of follow-up was 37.4% and mortality was 6.6% per year. Recurrence was higher in patients with a neuromedial profile and mortality was higher in patients with a nonneuromedial profile.

Keywords:
Syncope
Head-up tilt test
Mortality
Abbreviations:
OHS
SUE
VVS
Resumen
Introducción y objetivos

La evolución a largo plazo de los pacientes que padecen síncope, una vez descartada su etiología cardiaca, no se ha descrito en profundidad. Se describe la evolución a largo plazo de esta población.

Métodos

Durante 147 meses, se estudió a todos los pacientes remitidos a nuestra unidad de síncope tras haberse descartado una causa cardiaca.

Resultados

Se incluyó a 589 pacientes consecutivos, 313 de ellos mujeres (53,1%), con una mediana de 52 [34-66] años. A 405 (68,8%) se les diagnosticó síncope vasovagal (SVV); a 65 (11%), síncope por hipotensión ortostática (SHO), y a 119 (20,2%), síncope de etiología desconocida (SED). Durante una mediana de 52 [28-89] meses de seguimiento, 220 (37,4%) tuvieron recurrencias (el 21,7%, 2 o más recurrencias) y se produjeron 39 muertes (6,6%). La recurrencia del síncope se produjo en el 41% de los pacientes con SVV, el 35,4% del grupo con SHO y el 25,2% del de SED (p=0,006). La recurrencia se correlacionó en el análisis multivariado con la edad (p=0,002), el sexo femenino (p<0,0001) y el número de episodios previos (< 5 frente a ≥ 5; p <0,0001). Fallecieron 15 pacientes (3,5%) con SVV, 11 (16,9%) con SHO y 13 (10,9%) con SED (p=0,001), El análisis multivariado asoció edad (p=0,0001), diabetes (p=0,007) y diagnóstico de SHO (p=0,026) y SED (p=0,020) con la muerte.

Conclusiones

En los pacientes con síncope de origen no cardiaco, a los 52 meses de seguimiento, la tasa de recurrencias es del 37,4% y la de mortalidad, del 6,6%. Hay más recurrencias en los pacientes con perfil neuromediado y más mortalidad en los pacientes con perfil no neuromediado.

Palabras clave:
Síncope
Test de tabla basculante
Mortalidad

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