Han Sang-Kyoon, Yeom Seok-Ran, Lee Sung-Hwa, Park Soon-Chang, Kim Hyung-Bin, Cho Young-Mo, Park Sung-Wook
Department of Emergency Medicine, Pusan National University Hospital, Busan, Republic of Korea.
Department of Emergency Medicine, Pusan National University Hospital, Busan, Republic of Korea.
Am J Emerg Med. 2017 Feb;35(2):281-284. doi: 10.1016/j.ajem.2016.10.078. Epub 2016 Nov 2.
Despite the low diagnostic yield of echocardiogra0, it is often used in the evaluation of syncope. This study determined whether patients without abnormalities in the initial evaluation benefit from transthoracic echocardiogram (TTE) and the clinical factors predicting an abnormal TTE.
This study enrolled 241 patients presenting to the emergency department with syncope. The TTE results were analyzed based on risk factors suggesting cardiogenic syncope in the initial evaluation.
Of the 115 patients with at least one risk factor, 97 underwent TTE and 27 (27.8%) had TTE abnormalities. In comparison, of the 126 patients without risk factors, 47 underwent TTE and only 1 (2.1%) had TTE abnormalities. Significantly different factors between patients with normal and abnormal TTE findings were entered in a multiple logistic regression analysis, which yielded age [adjusted odds ratio (aOR), 1.09; 95% CI, 1.02-1.15; p=0.006], an abnormal electrocardiogram (ECG) (aOR, 7.44; 95% CI, 1.77-31.26; p=0.010), and a brain natriuretic peptide (BNP) level of >100pg/mL (aOR, 2.64; 95% CI, 1.21-5.73; p=0.011) as independent predictors of TTE abnormalities. The cutoff value of age predicting an abnormal TTE was 59.0years (area under the curve, 0.777; p<0.001).
A patient who is older than 59years or has an abnormal ECG or an elevated BNP level may benefit from TTE. Otherwise, TTE should be deferred in patients with no risk factors in the initial evaluation.
尽管超声心动图的诊断阳性率较低，但它仍常用于晕厥的评估。本研究旨在确定初始评估无异常的患者是否能从经胸超声心动图（TTE）检查中获益，以及预测TTE检查结果异常的临床因素。
本研究纳入了241例因晕厥就诊于急诊科的患者。根据初始评估中提示心源性晕厥的危险因素对TTE检查结果进行分析。
在115例至少有一项危险因素的患者中，97例接受了TTE检查，其中27例（27.8%）TTE检查结果异常。相比之下，在126例无危险因素的患者中，47例接受了TTE检查，只有1例（2.1%）TTE检查结果异常。将TTE检查结果正常和异常的患者之间有显著差异的因素纳入多因素逻辑回归分析，结果显示年龄[调整优势比（aOR），1.09；95%可信区间（CI），1.02 - 1.15；p = 0.006]、心电图（ECG）异常（aOR，7.44；95%CI，1.77 - 31.26；p = 0.010）以及脑钠肽（BNP）水平>100pg/mL（aOR，2.64；95%CI，1.21 - 5.73；p = 0.011）是TTE检查结果异常的独立预测因素。预测TTE检查结果异常的年龄截断值为59.0岁（曲线下面积，0.777；p < 0.001）。
年龄大于59岁、心电图异常或BNP水平升高的患者可能从TTE检查中获益。否则，对于初始评估无危险因素的患者应推迟进行TTE检查。
