期刊
HEART
卷 107, 期 22, 页码 1796-1804出版社
BMJ PUBLISHING GROUP
DOI: 10.1136/heartjnl-2020-318430
关键词
arrhythmias; cardiac; electrocardiography
资金
- Swiss National Science Foundation
- Swiss Heart Foundation
- Cardiovascular Research Foundation Basel (Switzerland)
- University Basel (Switzerland)
- University Hospital Basel (Switzerland)
- Freiwillige Akademische Gesellschaft Basel (Switzerland)
- Abbott
- BRAHMS
- Singulex
- Roche
- Emergency Medicine Foundation (Australia)
- Emergency Care Foundation (New Zealand)
- National Institutes of Health (USA) [R01HL111033]
In patients aged 40 years and older with syncope, a combination of seven ECG criteria enables rapid assessment of the likelihood that syncope was due to a cardiac cause. The study found that heart rate, QTc-interval, rhythm, atrioventricular block, ST-segment depression, bundle branch block, and ventricular extrasystole/non-sustained ventricular tachycardia were significant predictors for identifying a cardiac cause of syncope.
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.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据