Abstract 18522: Echocardiogram in the Evaluation of Patients With Syncope and Normal Electrocardiogram: Do We Need It
Background: Syncope is a major cause for emergency room visits and hospital admissions. The electrocardiogram (ECG) serves as an important and cheap diagnostic tool, but most patients undergo additional cardiac testing including echocardiogram. However, little is known about its benefit in patients with normal ECG.
Hypothesis: We hypothesize that patients with syncope and normal ECG are likely to have normal echocardiogram.
Methods: We conducted a retrospective chart review of adult patients admitted with syncope between Jan 2011 and Mar 2012. Demographics and cardiac testing were reviewed. Patients with positive drug screen or who didn’t meet our syncope definition were excluded. Study population was divided into two groups based on ECG. Abnormal ECG includes any arrhythmia, conduction delay, chamber hypertrophy and ST/T abnormalities. Abnormal echocardiogram includes any wall motion abnormality, decreased ejection fraction, significant valvular disease, pulmonary hypertension or chamber enlargement. Descriptive statistics with Confidence intervals (CIs), interquartile ranges (IQRs; 25%, 75%) and linear regression were done using SPSS 20.
Results: We identified 497 adult patients admitted with syncope. Only 198 met our inclusion criteria. Mean age was 58 years (25%, 75% IQR 48, 70), 40% Men, 50% Hispanics, 30% Black, 71% Hypertensive, 29% Diabetics, 13% with Coronary artery disease and 3% with congestive heart failure. Normal ECG group consists of 110 (56%; 95% CI: 49-63) patients. Echocardiogram was performed on 177 (89%; 95% CI: 85-94) patients, from them 16 (8%; 95% CI: 4 to 12) were abnormal and only 2 (2%; 95% CI: -1 to 4) were in patients with normal ECG. A correlation was found between the patients with normal ECG and normal Echocardiogram (P<0.001). On multiple linear regressions, predictors of abnormal echocardiogram were: Diabetes (β= - 0.145, p= 0.031), coronary artery disease (β= 4.32, p= <0.001), congestive heart failure (β= 0.147 p= 0.027), and abnormal ECG (β= 0.185, p= 0.006).
Conclusion: In conclusion, a normal ECG correlates with a normal echocardiogram in patients presented with syncope. Echocardiogram, frequently performed, may not be needed in this specific group of patients.
- © 2013 by American Heart Association, Inc.