Early and late-onset syncope: insight into mechanisms. (9th February 2022)

• Record Type: Journal Article
• Authors: Torabi, Parisa; Rivasi, Giulia; Hamrefors, Viktor; Ungar, Andrea; Sutton, Richard; Brignole, Michele; Fedorowski, Artur
• Is Part Of: European heart journal. Volume 43:Number 22(2022)
• Page Start: 2116
• Page End: 2123
• Publication Date: 2022-02-09
• Subjects: Vasovagal syncope -- Head-up tilt test -- Age at first syncope -- Ageing; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehac017
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Aims: Unexplained syncope is an important clinical challenge. The influence of age at first syncope on the final syncope diagnosis is not well studied. Methods and results: Consecutive head-up tilt patients ( n = 1928) evaluated for unexplained syncope were stratified into age groups <30, 30–59, and ≥60 years based on age at first syncope. Clinical characteristics and final syncope diagnosis were analysed in relation to age at first syncope and age at investigation. The age at first syncope had a bimodal distribution with peaks at 15 and 70 years. Prodromes (64 vs. 26%, P < 0.001) and vasovagal syncope (VVS, 59 vs. 19%, P < 0.001) were more common in early-onset (<30 years) compared with late-onset (≥60 years) syncope. Orthostatic hypotension (OH, 3 vs. 23%, P < 0.001), carotid sinus syndrome (CSS, 0.6 vs. 9%, P < 0.001), and complex syncope (>1 concurrent diagnosis; 14 vs. 26%, P < 0.001) were more common in late-onset syncope. In patients aged ≥60 years, 12% had early-onset and 70% had late-onset syncope; older age at first syncope was associated with higher odds of OH (+31% per 10-year increase, P < 0.001) and CSS (+26%, P = 0.004). Younger age at first syncope was associated with the presence of prodromes (+23%, P < 0.001) and the diagnoses of VVS (+22%, P < 0.001) and complex syncope (+9%, P = 0.018). Conclusion: In patients with unexplained syncope, first-ever syncope incidence has a bimodal lifetime pattern with peaks at 15 and 70 years. The majority of older patients present only recent syncope; OH and CSS are more common in this group. In patients with early-onset syncope, prodromes, VVS, and complex syncope are more common. Structured Graphical Abstract: The age distribution of first-ever syncope in 1928 patients with unexplained syncope and the proportions of head-up tilt diagnoses in the same group and in a subgroup of 836 patients aged ≥60 years at investigation.