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32. Cardiovascular Nursing
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Can we rule-out Cardiogenic Syncope at a first glance?
Session:
Painel 4- Arritmologia 3
Speaker:
Teresa Mota
Congress:
CPC 2020
Topic:
C. Arrhythmias and Device Therapy
Theme:
07. Syncope and Bradycardia
Subtheme:
07.6 Syncope and Bradycardia - Clinical
Session Type:
Posters
FP Number:
---
Authors:
Teresa Faria Da Mota; Pedro Oliveira De Azevedo; João De Sousa Bispo; Raquel Menezes Fernandes; Hugo Alex Costa; Nuno Marques; Jorge Mimoso; Ilidio Paulos De Jesus
Abstract
<p><strong>Introduction: </strong>Cardiogenic syncope is a worrisome diagnostic hypotesis in syncope patients, specially in an outpatient setting, considering that it may be associated with a worst prognosis. </p> <p><strong>Objective: </strong>To create a new practical predictive score that allows forecasting of a diagnosis of cardiogenic syncope (CSy), in out-patients.</p> <p><strong>Methods: </strong>The authors present an observational, retrospective, descriptive and correlational study including all patients referred to a first appointment at a Syncope Unit between January 1<sup>st</sup> 2015 and November 13<sup>th</sup> 2019. Patients were divided according to final diagnosis (CSy vs. remaining) and demographic/clinical information available at the 1<sup>st</sup> appointment clinical records were compared using Chi-square/Fisher test for categorical variables and t-Student test for continuous variables. Independent predictors of CSy were determined using a binary logistic regression model, with a predefined significance level of 0,05. Applying a discriminatory function and the Wilks lambda test, the authors determined a discriminant score for the studied groups.</p> <p><strong>Results: </strong>A total of 694 patients were included in the analysis, of which 51,9% were male, with a mean age of 63,6±21 years. Considering the total syncope population, 9,3% had a final diagnosis of Cardiogenic Syncope. After univariate analysis of the collected variables, the following showed a statistically significant relation with the diagnosis: age (p>0,001), arteria hypertension (p>0,001), ex-smoking (p=0.028), beta-blockers (p=0,010), ACEi (p=0,013), CCB (p<0,001), diuretics (p=0,005), nitrates (p=0,037), amiodarone (p= 0,041), previous atrial fibrillation (p<0,001) or SV tachycardia (p<0,001), present bradycardia (p=0,015), peripheral oedema (p=0,031) and an EKG showing AF (p<0,001), 1<sup>st</sup> degree AV block (p=0,027) or 2<sup>nd</sup> degree AVb Mobitz II (p=0,048). However, after multivariate analysis, independent predictors were restricted to: CCB (p=0,017), previous SVt (p=0,03), peripheral oedemas (p=0,046) and the presence of Mobitz II on the first appointment EKG (p=0,015).</p> <p>Using these variables, the authors built a Predictive Score in order to evaluate the risk of having a final diagnosis of CSy with the following formula: - 0,512 + (1,465 x CCB) + (4,771 x TSV) + (1,591 x peripheral oedema) + (6,010 x Mobitz II). In order to apply this function, variables should be substituted by 1 or 0, depending on whether the condition they specify is present or not. In this score, the optimal discrimination cut-off was 0,38, with a 98,7% specificity, and a discriminant power of 90,4%.</p> <p><strong>Conclusion: </strong>Using simple and easily evaluated variables, the authors were able to develop a tool that might help to safely discharge the diagnostic hypothesis of Cardiogenic Syncope, at a first appointment. Further validation is required in a different population, in order to apply the presented function in a real-world context. </p>
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