Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.
GREAT network, Rome, Italy.
Heart. 2021 Nov;107(22):1796-1804. doi: 10.1136/heartjnl-2020-318430. Epub 2021 Jan 27.
To develop an ECG-based tool for rapid risk assessment of a cardiac cause of syncope in patients ≥40 years.
In a prospective international multicentre study, 2007 patients ≥40 years presenting with syncope were recruited in the emergency department (ED) of participating centres ranging from large university hospitals to smaller rural hospitals in eight countries from May 2010 to July 2017. 12-Lead ECG recordings were obtained at ED presentation following the syncopal event. The primary diagnostic outcome, a cardiac cause of syncope, was centrally adjudicated by two independent cardiologists using all available clinical information including 12-month follow-up. ECG predictors for a cardiac cause of syncope were identified using penalised backward selection and a continuous-scale likelihood was calculated based on regression analysis coefficients. Findings were validated in an independent US multicentre cohort including 2269 patients.
In the derivation cohort, a cardiac cause of syncope was adjudicated in 267 patients (16%). Seven ECG criteria were identified as predictors for this outcome: heart rate and QTc-interval (continuous predictors), rhythm, atrioventricular block, ST-segment depression, bundle branch block and ventricular extrasystole/non-sustained ventricular tachycardia (categorical predictors). Diagnostic accuracy of these combined predictors for a cardiac cause of syncope was high (area under the curve 0.80, 95% CI 0.77 to 0.83). Overall, 138 patients (8%) were rapidly triaged towards rule-out and 181 patients (11%) towards rule-in of a cardiac cause of syncope. External validation showed similar performance.
In patients ≥40 years with a syncopal event, a combination of seven ECG criteria enabled rapid assessment of the likelihood that syncope was due to a cardiac cause.
NCT01548352 (BASEL IX), NCT01802398 (SRS study).
开发一种基于心电图的工具，用于快速评估 40 岁以上患者心源性晕厥的风险。
在一项前瞻性国际多中心研究中，2010 年 5 月至 2017 年 7 月，从 8 个国家的大型大学医院到较小的农村医院，在参与中心的急诊科（ED）共招募了 2007 名年龄≥40 岁且伴有晕厥的患者。在晕厥发作后于 ED 就诊时获取 12 导联心电图记录。两名独立的心脏病专家使用包括 12 个月随访在内的所有可用临床信息，对中心裁定的主要诊断结果（心源性晕厥）进行了评估。使用惩罚后向选择和基于回归分析系数的连续尺度似然来识别心电图预测心源性晕厥的指标。在包括 2269 名患者的独立美国多中心队列中对结果进行了验证。
在推导队列中，267 名患者（16%）被裁定为心源性晕厥。确定了 7 个心电图标准作为该结果的预测指标：心率和 QTc 间期（连续预测指标）、节律、房室传导阻滞、ST 段压低、束支传导阻滞和室性期前收缩/非持续性室性心动过速（分类预测指标）。这些联合预测指标对心源性晕厥的诊断准确性较高（曲线下面积 0.80，95%置信区间 0.77 至 0.83）。总体而言，138 名患者（8%）被快速分诊为排除，181 名患者（11%）被分诊为心源性晕厥。外部验证显示了类似的性能。
在年龄≥40 岁且有晕厥事件的患者中，7 个心电图标准的组合可快速评估晕厥是否由心源性原因引起的可能性。
NCT01548352（BASEL IX），NCT01802398（SRS 研究）。
