Syncope etiology and prognosis in patients aged over 35 years
Abstract
Aim. To explore the etiology and prognosis of newly-onset syncope in patients aged over 35 years.
Material and methods. The study included 502 patients aged 36-90 years. Clinical characteristics, laboratory and instrumental data, syncope recurrence, all-cause and cardiovascular mortality outcomes were analyzed retrospect-tively, in regard to syncope etiology. The association of syncope etiology with all-cause and cardiovascular mortality was examined by Kaplan-Meier method; Cox models were used to adjust for demographic characteristics and co-morbidities.
Results. Major syncope etiology groups included: reflex-mediated syncope in 14% of the patients, cardiac – in 10%, neurogenic – in 6%, and orthostatic – in 12%. Syncope etiology remained unexplained in 45% of the cases. Total mortality was higher than that for general population of the same age and sex, but similar after co-morbidity adjustment. Syncope etiology was not associated with co-morbidity-adjusted all-cause mortality. Cardiovascular mortality was significantly higher in patients with cardiac syncope, compared to individuals with unexplained syncope: adjusted hazard ratio [95% confidence interval] 2.44 [1,025,83] (p=0,044).
Conclusion: The cause of newly-onset syncope can be identified in a half of the patients over 35 years. In this group, high mortality, irrespective of syncope etiology, is mainly explained by concomitant disease burden.
About the Authors
V. N. Khirmanov
I.I. Mechnikov St. Petersburg State Medical Academy, St. Petersburg
Russian Federation
Russian Federation
O. A. Rusanov
I.I. Mechnikov St. Petersburg State Medical Academy, St. Petersburg
Russian Federation
Russian Federation
N. Jarmukli
University of Virginia, Salem
Russian Federation
Russian Federation
References
1. Soteriades ES, Evans JC, Larson MG, et al. Incidence and prognosis of syncope. N Engl J Med 2002; 347: 878-85.
2. Миллер О.Н., Бондарева З.Г., Гусева И.А. Причины синкопальных состояний у лиц молодого возраста. РКЖ 2003; 3: 71-6.
3. Гуков А.О., Жданов А.М.. Проблемы диагностики и лечения больных с неврокардиогенными синкопальными состояниями. Кардиология 2000; 2: 92-6.
4. Charlson ME, Pompei P, Ales KL, et al. A new methods of classifiying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 50: 373-83.
5. Hutchinson TA, Thomas DC, MacGibbon B. Predicting survival in adults with end stage renal disease – an age equivalence index. Ann Int Med 1982; 96: 417-23.
6. Kenny RA. Syncope in the elderly: diagnosis, evaluation, and treatment. J Cardiovasc Electrophysiol 2003; 14: S74-7.
7. Manolis AS. Evaluation of patients with syncope: focus on age related differences. ACC Curr J Rev 1994; 13-8.
8. Dougnac A, Gonzalez R, Kychenthal A, et al. Syncope: etiology, prognosis, and relationship to age. Aging 1991; 3(1): 63-72.
9. Kenny RA, Kalaria R, Ballard C. Neurocardiovascular instability in cognitive impairment and dementia. Ann N Y Acad Sci 2002; 977: 183-95.
10. Lipsitz LA, Wei JY, Rowe JW. Syncope in an elderly, institutionalized population: prevalence, incidence and associated risk. Q J Med 1985; 54: 45-54.
11. Lipsitz LA, Pluchino FC, Wei JY, et al. Syncope in institutionalized elderly: the impact of multiple pathological conditions and situational stress. J Chronic Dis 1986; 39: 619-30.
12. Kapoor WN. Syncope in older persons. J Am Geriatr Soc 1994; 42(4): 426-36.
13. Kapoor W, Snustad D, Peterson J, et al. Syncope in the elderly. Am J Med 1986; 80: 419-28.
14. Linzer M, Yang EH, Estes NA III, et al. Diagnosing syncope. Part 1. Value of history, physical examination, and electrocardiography. Ann Intern Med 1997; 126: 989-96.
15. Kapoor W. Evaluation and outcome of patients with syncope. Medicine 1990; 69: 160-75.
16. Silverstein MD, Singer DE, Mulley A, et al. Patients with syncope admitted to medical intensive care units. JAMA 1982; 248: 1185-9.
17. Lee RT, Cook EF, Day SC, et al. Long-term survival after transient loss of consciousness. J Gen Intern Med 1988; 3: 337-43.
18. Getchell WS, Larsen GC, Morris CD, et al. Epidemiology of syncope in hospitalized patients. J Gen Intern Med 1999; 14(11): 677-87.
Review
For citations:
Khirmanov V.N., Rusanov O.A., Jarmukli N. Syncope etiology and prognosis in patients aged over 35 years. Cardiovascular Therapy and Prevention. 2007;6(1):84-88. (In Russ.)
Views:
611
Email this article 
