Abstract 16311: The Role of Echocardiography in Patients With Syncope: A Single-Center Experience

IntroductionSyncope is a symptom complex comprising of a brief loss of consciousness associated with an inability to maintain postural tone, leading to a transient decrease in cerebral blood flow, that resolves completely and doesn’t require any interventions. Syncope accounts for 3% of ED visits and 1-6% of all hospital visits. 2D-transthoracic echocardiography (TTE) is a useful tool to detect underlying structural heart disease which can lead to syncope e.g., aortic stenosis, atrial masses. However, it is used non-judiciously as a screening tool in patients admitted to our observation floor. The aim of this study was to find the subgroups of patients with syncope who would benefit the most from a TEE.HypothesisTo analyze the hypothesis that 2D-transthoracic echocardiography (TTE) is overused and is low yield in the evaluation of syncope patients, especially if they have a normal physical exam and EKGMethodsWe did a retrospective chart review of all patients aged 18 years or older, admitted to our hospital with a primary diagnosis of syncope between January 2015 and January 2017 to determine the frequency and findings of echo in all these patients. The baseline characteristics, demographics were taken into account for the inclusion of these patients into the study.ResultsA total of 369 patients were initially studied but only 139 patients were included in the final analysis based on the inclusion criteria. Among the high-risk patients (i.e abnormal Physical exam or an abnormal EKG), 43.75% had a significant echocardiographic finding. While among low-risk patients (i.e normal EKG and exam), 10% had a significant finding. Patients with abnormal EKG or examination findings were 7.08 times (95% CI= 2.89-17.3) more likely to have an abnormal echocardiogram (p < 0.001).ConclusionsOur study suggests that the diagnostic yield of 2D-TTE in the absence of an abnormal physical exam and/or abnormal EKG is very limited and may add an extra burden on the finances and resources of both the patient and the hospital.