Materiały źródłowe

• #1

  https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/cardiology/syncope/

  The overall prognosis of syncope depends on the underlying cause. Patients with syncope with structural heart disease and primary electrical disease are at high risk of overall mortality and sudden cardiac death. Young patients with reflex syncope have an excellent prognosis. […] Morbidity in patients with syncope is associated with recurrence of episodes and physical injury. In population studies, approximately a third of patients have recurrence of syncope in 3 years of follow up, and the rate of recurrence seems to be dependent on the number of previous episodes, but independent of gender, tilt test results, severity and presence of heart disease. The predicted recurrence in 1 to 2 years for patients with 1 or 2 syncope episodes is 15% to 20% whereas for patients with 3 syncope episodes it is 36% to 45%. Young patients with psychiatric disease have high rates of recurrence of pseudosyncope.

• #1 Syncope: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/811669-overview

  Cardiac syncope has a poorer prognosis than other forms of syncope; the 1-year endpoint mortality has been shown to be as high as 45%. […] Patients with cardiac syncope may be significantly restricted in their daily activities, and the occurrence of syncope may be a symptom of their underlying disease progression. […] Syncope of any etiology in a patient with cardiac conditions (to be differentiated from cardiac syncope) has also been shown to imply a poor prognosis. […] Patients with New York Heart Association (NYHA) functional class III or IV who have any type of syncope have a mortality as high as 25% within 1 year. […] However, some patients do well after definitive surgical treatment or pacemaker placement. […] Evaluation by a cardiologist for pacemaker placement should be considered in select patients older than 40 years who have recurrent syncope that is confirmed to be neurally mediated syncope (NMS) with a documented period of asystole.

• #2 Syncope: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/811669-overview

  Cardiac syncope has a poorer prognosis than other forms of syncope; the 1-year endpoint mortality has been shown to be as high as 45%. […] Patients with cardiac syncope may be significantly restricted in their daily activities, and the occurrence of syncope may be a symptom of their underlying disease progression. […] Syncope of any etiology in a patient with cardiac conditions (to be differentiated from cardiac syncope) has also been shown to imply a poor prognosis. […] Patients with New York Heart Association (NYHA) functional class III or IV who have any type of syncope have a mortality as high as 25% within 1 year. […] However, some patients do well after definitive surgical treatment or pacemaker placement. […] Evaluation by a cardiologist for pacemaker placement should be considered in select patients older than 40 years who have recurrent syncope that is confirmed to be neurally mediated syncope (NMS) with a documented period of asystole.

• #2 Cardiac Syncope – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK526027/

  Patients with easily treatable etiologies of cardiac syncope will generally have a good prognosis with adequate treatment. […] Patients with advanced heart failure and syncope, however, have a 45% one-year mortality. […] Patients with cardiac syncope are also more likely to have recurrent syncopal events with an estimated recurrence rate of 33% within 3 years. […] Recurrent syncope can worsen a patient’s quality of life, especially if syncopal events result in broken bones, intracranial bleeds, or other traumatic injuries. […] The outcomes of patients with a treatable cause of cardiac syncope are good. […] Cardiac syncope is often first identified by primary care providers and emergency department clinicians. […] Treatment for cardiac syncope is offered to prevent the patient’s morbidity, physical injuries, and monetary costs of recurrent syncopal events and prevent sudden cardiac death. […] The management of cardiac syncope varies widely and is essentially based on managing the specific condition which precipitated the syncopal event.

• #3 Syncope: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/811669-overview

  Noncardiac syncope seems to have no effect on overall mortality and includes syncope due to vasovagal response, autonomic insufficiency, situations, and orthostatic positions. […] Vasovagal syncope has a uniformly excellent prognosis. […] This condition does not increase the mortality, and recurrences are infrequent. […] Situational syncope and orthostatic syncope also have an excellent prognosis. […] They do not increase the risk of death; however, recurrences do occur and are sometimes a source of significant morbidity in terms of quality of life and secondary injury. […] Syncope of unknown etiology generally has a favorable prognosis, with 1-year follow-up data showing a low incidence of sudden death (2%), a 20% chance of recurrent syncope, and a 78% remission rate. […] Data suggest that patients with cardiac syncope are more likely to experience a poor outcome.

• #4

  https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/cardiology/syncope/

  The overall prognosis of syncope depends on the underlying cause. Patients with syncope with structural heart disease and primary electrical disease are at high risk of overall mortality and sudden cardiac death. Young patients with reflex syncope have an excellent prognosis. […] Morbidity in patients with syncope is associated with recurrence of episodes and physical injury. In population studies, approximately a third of patients have recurrence of syncope in 3 years of follow up, and the rate of recurrence seems to be dependent on the number of previous episodes, but independent of gender, tilt test results, severity and presence of heart disease. The predicted recurrence in 1 to 2 years for patients with 1 or 2 syncope episodes is 15% to 20% whereas for patients with 3 syncope episodes it is 36% to 45%. Young patients with psychiatric disease have high rates of recurrence of pseudosyncope.

• #5 Syncope: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/811669-overview

  Patients who have a significant cardiac history and those who seem to have a cardiac syncope (because of associated chest pain, dyspnea, cardiac murmur, signs of congestive heart failure (CHF), or ECG abnormalities) should be considered to be at increased risk. […] Most published methods of risk stratification take into account cardiac symptoms and risk factors. […] Morbidity from syncope includes recurrent syncope, which occurs in 20% of patients within 1 year of the initial episode. […] Syncope in a patient with poor baseline cardiac function portends a poor prognosis, irrespective of etiology. […] Patients with cardiac syncope appear to do worse than patients with noncardiac syncope. […] Risk of serious outcome and death in patients with syncope increases with higher peak troponin concentrations, according to a prospective cohort study of 338 patients who had plasma troponin I levels measured with a sensitive assay 12 hours after syncope.

• #6 Syncope: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/811669-overview

  The percentage of patients with a serious outcome increased across patients divided into quintiles on the basis of peak troponin concentration at 1 month (0%, 9%, 13%, 26%, 70%) and at 1 year (10%, 22%, 26%, 52%, 85%). […] Decision rules may assist in identifying patients who are at risk. […] The San Francisco Syncope Rule (SFSR) was determined to have a 96% sensitivity for identifying patients at immediate risk for serious outcomes within 7 days, on the basis of the presence of abnormal ECG findings, a history of CHF, dyspnea, a hematocrit level lower than 0.30, and hypotension. […] The presence of these findings should prompt serious consideration for hospital admission.

• #7

  https://link.springer.com/article/10.1007/s11845-023-03395-6

  Various scores have been derived for the assessment of syncope patients in the emergency department (ED). […] We aimed to compare the effectiveness of Canadian Syncope Risk Scores (CSRS), San Francisco Syncope Rules (SFSR), and Osservatorio Epidemiologico sulla Sincope nel Lazio (OESIL) risk scores in predicting the risk of major adverse cardiac events (MACE) and mortality among syncope patients within 30 days of the initial ED visit. […] Our primary outcome was a 30-day mortality. […] The rate of MACE development in the 30-day follow-up of the patients was 12.8% (n=54). […] The 30-day mortality was 5.5% (n=23). […] CSRS was found to have the highest predictive power of mortality (AUC: 0.869, 95% CI 0.7990.939, p0.001). […] CSRS (OR: 1.402, 95% CI: 1.0531.867, p=0.021) was found to be an independent predictor of the 30-day mortality. […] The CSRS may be used as a safety risk score for a 30-day risk of MACE and mortality after discharge from the emergency department.

• #8 Role of Biomarkers in the Prediction of Serious Adverse Events after Syncope in Prehospital Assessment: A Multi-Center Observational Study

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7141384/

  Syncope is defined as the nontraumatic, transient loss of awareness of rapid onset, short duration and with complete spontaneous recovery, and accounts for 1%3% of all visits to the emergency department. […] The objective of this study was to evaluate the predictive capacity of the National Early Warning Score 2 (NEWS2) and prehospital lactate (pLA), individually and combined, at the prehospital level to detect patients with syncope at risk of early mortality (within 48 h) in the hospital environment. […] Early mortality affected 21 patients (5.8%). […] The combined score formed by the NEWS2 and the pLA (NEWS2-L) obtained an AUC of 0.948 (95% CI: 0.881) and an odds ratio of 86.25 (95% CI: 11.36645.57), which is significantly higher than that obtained by the NEWS2 or pLA in isolation (p = 0.018).

• #9 Role of Biomarkers in the Prediction of Serious Adverse Events after Syncope in Prehospital Assessment: A Multi-Center Observational Study

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7141384/

  The NEWS2-L can help stratify the risk in patients with syncope treated in the prehospital setting, with only the standard measurement of physiological parameters and pLA. […] The main outcome variable was early hospital mortality (within the first 48 h) from any cause, in line with previous studies. […] After prehospital care, 5.8% (21 cases) of patients with syncope died in less than 48 h. […] Nonsurvivors were significantly older, with high scores of NEWS2 and pLA, and presented more PALS and admission to ICU. […] The prognostic precision of the scores for predicting early mortality is represented in Figure 2a. The NEWS2-L, with an AUC of 0.948 (95% CI: 0.881) had the best performance score. […] Our data indicate that a NEWS2-L score of 9.5 or higher implies with high probability a risk of death within 48 h, and a score of 6.9 or higher was associated with a higher frequency of advanced life support maneuvers at the scene or on the road, which means it can help us detect high-risk patients who may need advanced maneuvers. […] In summary, the NEWS2-L can help identify patients who have undergone syncope and have a high-risk of needing ICU or early mortality in the prehospital setting, with only the standard measurement of physiological parameters and pLA.

• #10 Syncope: Evaluation and Differential Diagnosis | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0301/p303.html

  Syncope is classified as neurally mediated, cardiac, and orthostatic hypotension. Neurally mediated syncope is the most common type and has a benign course, whereas cardiac syncope is associated with increased morbidity and mortality. Patients with presyncope have similar prognoses to those with syncope and should undergo a similar evaluation. […] Although syncope is associated with serious risks, short-term mortality is low (i.e., 0.7% at 10 days and 1.6% at 30 days). At one year, the mortality rate is 8.4%; one-third of these are attributed to cardiovascular causes. […] Management of syncope remains a challenge, particularly in identifying patients with potentially life-threatening etiologies. […] The decision to perform an expedited and monitored evaluation of patients presenting with syncope is based on the likelihood of short-term adverse outcomes.

• #11 A Hybrid Model for 30-Day Syncope Prognosis Prediction in the Emergency Department

  https://www.mdpi.com/2075-4426/14/1/4

  A Hybrid Model for 30-Day Syncope Prognosis Prediction in the Emergency Department […] The aim of the present study was to develop and compare the performance of ML-based models in predicting the risk of clinically significant outcomes in patients presenting to the ED for syncope. […] In conclusion, we developed an ML-based model characterized by a commendable capability to predict adverse events within 30 days post-syncope evaluation in the ED. […] The aim of the present study is to develop ML-based models to predict 30-day adverse events among patients admitted to the ED for a syncopal episode. […] After 30 days of follow-up, 45 (16.9%) patients had serious outcomes and three of these patients died. […] The hybrid model showed significantly greater discrimination capability than the XG boost model (p < 0.001).

• #12 A Hybrid Model for 30-Day Syncope Prognosis Prediction in the Emergency Department

  https://www.mdpi.com/2075-4426/14/1/4

  These findings indicate that by solely utilizing data related to the presentation of the syncope episode, a patient’s medical history, vital signs, and ECG—all of which a clinician can easily gather during the initial assessment of a patient with syncope—it is feasible to predict 30-day adverse events with good discrimination and reliable calibration. […] In the present study, we aimed to explore the potential of supervised ML-based models in automating the risk stratification process of the patient with syncope. […] We developed a hybrid model characterized by a commendable capability to predict adverse events occurring within 30 days post-syncope evaluation in the ED.

• #13 A Hybrid Model for 30-Day Syncope Prognosis Prediction in the Emergency… | Mauro Gatti

  https://www.linkedin.com/posts/maurogatti29_a-hybrid-model-for-30-day-syncope-prognosis-activity-7143157616456769536-IlDG

  Can we combine Machine Learning and Clinical Knowledge to predict risk of clinically significant outcomes in patients presenting to the ED for syncope? […] In this article, we have shown how Machine Learning and Clinical Knowledge expressed in the form of simple logical rules can be used to predict the prognosis of patients with syncope. […] A Hybrid Model for 30-Day Syncope Prognosis Prediction in the Emergency Department.

• #14 Machine learning-based prediction of fainting during blood donations using donor properties and weather data as features | BMC Medical Informatics and Decision Making | Full Text

  https://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/s12911-022-01971-x

  Fainting is a well-known side effect of blood donation. Such adverse experiences can diminish the return rate for further blood donations. Identifying factors associated with fainting could help prevent adverse incidents during blood donation. […] Machine-learning algorithms can establish prediction models of fainting in blood donors. These new tools can reduce adverse reactions during blood donation and improve donor safety and minimize negative associations relating to blood donation. […] The main result of our study is that fainting reactions during blood donations can be predicted with similar good precision by seven mathematically different machine learning algorithms using the properties of the blood donor and local weather reports. […] A correct and timely prediction of fainting episodes might enable one to improve the donation experience by making adequate preparations and monitoring patients at risks, such as pre-donation hydration or applied muscle tension.

• #15 Machine learning-based prediction of fainting during blood donations using donor properties and weather data as features | BMC Medical Informatics and Decision Making | Full Text

  https://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/s12911-022-01971-x

  The results of our machine learning prediction model showed that systolic and diastolic blood pressure are the two most essential features predicting fainting episodes. […] However, the seven most important features are all weather-associated parameters, indicating that ambient conditions might significantly predict donation-associated fainting. […] We obtained very high AUC- and F1-values for all seven models indicating the vast potential of these algorithms for predicting fainting episodes in a clinical setting by some basic demographic parameters, the questionnaire every blood donor had to fill in before the donation procedure, and the weather data. […] The correct prediction of fainting episodes might improve the donation experience by preparing and monitoring patients at risk. […] In summary, prediction models with machine-learning algorithms can be helpful in reducing negative experiences during blood donation and contribute to improving donor safety. Using modern machine learning algorithms, it is possible to identify blood donors that will have no vasovagal reaction through the donation procedures if donors properties and weather data are used.

• #16

  https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/cardiology/syncope/

  In patients with syncope presenting to the emergency department, 29.1% have minor trauma, 4.7% have major trauma, and in older patients with carotid disease, 43% have major trauma. Morbidity is particularly high in the elderly, and is associated with loss of confidence, fear of falling, depression, fractures, and institutionalization.

• #17 Cardiac Syncope – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK526027/

  Patients with easily treatable etiologies of cardiac syncope will generally have a good prognosis with adequate treatment. […] Patients with advanced heart failure and syncope, however, have a 45% one-year mortality. […] Patients with cardiac syncope are also more likely to have recurrent syncopal events with an estimated recurrence rate of 33% within 3 years. […] Recurrent syncope can worsen a patient’s quality of life, especially if syncopal events result in broken bones, intracranial bleeds, or other traumatic injuries. […] The outcomes of patients with a treatable cause of cardiac syncope are good. […] Cardiac syncope is often first identified by primary care providers and emergency department clinicians. […] Treatment for cardiac syncope is offered to prevent the patient’s morbidity, physical injuries, and monetary costs of recurrent syncopal events and prevent sudden cardiac death. […] The management of cardiac syncope varies widely and is essentially based on managing the specific condition which precipitated the syncopal event.

• #18 Syncope: Evaluation and Differential Diagnosis | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0301/p303.html

  High-risk patients should be admitted for further evaluation. […] The presence of cardiovascular disease predicts a cardiac etiology of syncope with 85% to 94% sensitivity and 64% to 83% specificity. […] The treatment of syncope is directed at the underlying cause. Morbidity and mortality are generally low except in cardiac syncope; therefore, patient reassurance is an important part of treatment.

• #19 The complexity of hemodynamic response to the tilt test with and without nitroglycerine provocation in patients with vasovagal syncope | Scientific Reports

  https://www.nature.com/articles/s41598-018-32718-2

  The investigation showed that the reactions of autonomic nervous system during tilt test and before syncope are similar for positive result of passive tilt test and positive result of tilt test with provocation. […] Significant differences were denoted for all signals just before the syncope (RRI, sBP, dBP: p=0,00001 and SV: p=0.01). […] The symptoms of vasovagal syndrome in elderly people are different than in the young and rather atypical. […] The physiological mechanism of vasovagal syncope is still not fully understood. […] The pathophysiology of neurocardiogenic syncope is heterogeneous. […] The experience gained so far and assessment of the results of tilt test show that a short pause in cerebral perfusion (lasting 68s) or a decrease in systolic blood pressure (sBP) down to 60mmHg or less is associated with syncope.

• #20 The complexity of hemodynamic response to the tilt test with and without nitroglycerine provocation in patients with vasovagal syncope | Scientific Reports

  https://www.nature.com/articles/s41598-018-32718-2

  The tilt table test is not a painful test for the patients, but as it is a lengthy procedure it is uncomfortable and inconvenient. […] The possibility of syncope prediction even shortly before its occurrence would allow to improve the quality of patients life. […] The analysis of HUTT outcome prediction should focus on more than a single biosignal. […] The described investigations indicate that the analysis of HUTT outcome prediction should focus on more than a single biosignal. […] The significant decrease of SV was also observed by Zadi et al. after 2minutes and 5minutes of tilt. […] The analysis mentioned above described HUTT in two groups of patients: with and without positive outcome. […] The presented results are not consistent and lead to a conclusion that the role of parameters based on ICG measurement in HUTT test is still not sufficiently explained and requires further investigations. […] Our investigations are an example of a practical application of Sample Entropy for vasovagal syncope assessment. […] Therefore, only this parameter (or another one obtained from ICG measurement) appears to be a promising candidate for future investigation.

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