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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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A. Basics
B. Imaging
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01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
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21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
36. Basic Science
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High-risk features and event predictors in patients with unexplained syncope from the young SCD-SOS cohort
Session:
Posters 3 - Écran 6 - Arritmologia
Speaker:
Mafalda Carrington
Congress:
CPC 2019
Topic:
C. Arrhythmias and Device Therapy
Theme:
07. Syncope and Bradycardia
Subtheme:
07.6 Syncope and Bradycardia - Clinical
Session Type:
Posters
FP Number:
---
Authors:
Mafalda Carrington; Antonio; Rogerio Teixeira; Lino Gonçalves; Rui Providência
Abstract
<p><u>Introduction:</u> Sudden Cardiac Death – Screening Of risk factorS (SCD-SOS) survey aimed to screen for warning signs of potential channelopathies and cardiomyopathies that may course with sudden cardiac death in the young. It consisted in an ECG and a digital-based previously validated questionnaire, that were provided by 12099 individuals.</p> <p><u>Purpose:</u> We aimed to characterize the high-risk features and predictors of unexplained syncope in the young SCD-SOS cohort.</p> <p><u>Methods:</u> Based on the detailed questionnaire, we determined the most probable etiology of the transient loss of consciousness (TLOC) episodes. According to the 2018 ESC syncope guidelines, reflex syncope (RS, either vasovagal or situational) was precipitated by pain, emotion, fear, warm environment, or standing, and was associated with at least one typical progressive prodrome (pallor, sweating, and/or nausea). Orthostatic hypotension (OH) was assumed if typical triggers were described in the absence of any of the previous prodromes. The remaining causes were ascertained based on the specifications provided by the individuals and unexplained syncope (US) was an exclusion diagnosis. We analyzed minor and major syncope high-risk (HR-) features, as well as basal and ECG characteristics as potential predictors. Type-1 Brugada pattern was detected in 0,15%, and WPW in 0,28% of the individuals.</p> <p><u>Results:</u> The lifetime cumulative incidence of TLOC in our population was 26,6% (n=3211), 75,8% (n=2433) were female and the mean age was 22±7 years-old (yo). Among individuals with a history of TLOC, 59,9% (n=1923) had RS and 7,8% (n=251) reported episodes compatible with OH. Several other causes for the TLOC were identified: 10,5% (n=337) reported hypoglycemia/insufficient food intake, 3,7% (n=119) drugs/alcohol, 3,2% (n=104) other diseases (ex:anemia), 1,3% (n=42) head trauma and 1,2% (n=40) epileptic seizures. Syncope associated with fever was detected in 1,1% (n=36), and 0,4% (n=13) of these described a concomitant trigger/prodrome. We found a history of US in 14,9% (n=477) of the individuals, and that a history of SCD in relatives before 40 yo, QTc<360ms, male sex and participation in competitive sports predicted US. In the characterization of major HR-features, in opposition to palpitations preceding syncope, syncope during or after exertion was independently associated with US (see Figure). At least one major HR-feature was identified in 33,5% (n=160) of the individuals with US, comparing to 20,6% (n=562) in individuals with the remaining causes of TLOC (p<0,001). </p> <p><u>Conclusions:</u> We conclude that the lifetime cumulative incidence of TLOC in the young is high and that it remained unexplained in an important proportion of individuals. A history of SCD in relatives and short QTc were the best predictors of US. Additionally, HR-features of syncope should be cautiously evaluated in the young.</p>
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