In patients with syncope or near-syncope, five risk factors may help predict the likelihood of significant findings on echocardiography (ECG), a new study found.
Researchers performed a prospective, observational cohort study at 11 U.S. EDs to help develop a risk-stratification tool for clinically significant ECG findings in adults ages 60 years and older who presented with syncope or near-syncope and had transthoracic ECG (TTE) on their index visit. Syncope was defined as transient loss of consciousness associated with postural loss of tone and involving immediate, spontaneous, complete recovery, while near-syncope was defined as “the sensation of imminent loss of consciousness.” The study's primary outcome was significant findings on TTE; clinical, electrocardiogram, and laboratory data were also collected. The authors used multivariable logistic regression analysis to identify predictors of clinically significant ECG findings. The study results were published Sept. 26 by the Journal of Hospital Medicine.
Overall, 3,686 patients were enrolled in the study, 995 of whom (27%) received TTE and 215 of whom (22%) had a significant TTE finding. Patients who received TTE had a mean age of 74 years, and more than half (55%) were men. Significant findings on TTE were found to be more likely in patients who had a history of congestive heart failure, a history of coronary artery disease, an abnormal electrocardiogram, a high-sensitivity troponin-T level above 14 pg/mL, and an N-terminal pro B-type natriuretic peptide level above 125 pg/mL. The authors used these five variables to make up the ROMEO (Risk Of Major Echocardiography findings in Older adults with syncope) criteria. They determined that a ROMEO score of zero had a sensitivity of 99.5% (95% CI, 97.4% to 99.9%) and a specificity of 15.4% (95% CI, 13.0% to 18.1%) for excluding significant ECG findings in this population.
The authors noted that they enrolled only patients ages 60 years and older, that their results may have been affected by sampling bias, and that they did not validate their score. In addition, they pointed out that potential cost savings are uncertain because of the higher laboratory costs involved in ordering tests for high-sensitivity troponin-T and an N-terminal pro B-type natriuretic peptide, among other limitations. They concluded that their tool could help physicians determine which older patients presenting with syncope might not require TTE. “If validated, this tool could help optimize resource utilization, and increase the value of healthcare for patients presenting with syncope,” they wrote.