Circadian, weekly, seasonal, and temperature-dependent patterns of syncope aetiology in patients at increased risk of cardiac syncope
Circadian, weekly, seasonal, and temperature-dependent patterns of syncope aetiology in patients at increased risk of cardiac syncope
复制标题
DOI：
10.1093/europace/euy186
复制
发表时间：
2019-03-01
期刊：
影响因子：
6.1
通讯作者：
Osswald, Stefan
中科院分区：
文献类型：
--
作者：
de Lavallaz, Jeanne du Fay;Badertscher, Patrick;Osswald, Stefan
目的是未知是否心源性晕厥，也可能是其他晕厥的病因表现出昼夜节律，每周，季节性和温度依赖的patterns.Methods和results我们前瞻性地记录了确切的时间，日期，和晕厥的患者> 40岁的急诊室在诊断多中心研究的外部温度。两名独立的心脏病专家/急诊医生根据临床检查（包括1年随访）期间获得的所有信息裁定最终诊断。在1230例患者中，14.6%的裁定病因为心源性，39.2%的裁定病因为反射性，25.7%的裁定病因为直立性，9.7%的裁定病因为其他非心源性，10.8%的裁定病因未知。各种晕厥病因在白天的发生率明显高于夜间（P < 0.01）。反射性晕厥和直立性晕厥的患病率峰值较宽，80.9%的事件发生在4 am至4 pm之间，心源性晕厥的患病率峰值较窄，70.1%的事件发生在8 am至2 pm之间。多数晕厥病因呈周规律，主要发生在周一至周五（P < 0.01）。反射性晕厥呈季节性变化，冬季多见（P < 0.01），心源性晕厥全年无变化。晕厥多发生在室外温度最低时。总的来说，观察到的模式为心脏性晕厥的模式观察其diagnosis.Conclusion晕厥的病因在> 40岁的患者显示昼夜节律，每周，季节性和温度依赖性模式。不幸的是，这些模式不允许可靠地区分心源性晕厥与其他病因。
Aims It is unknown whether cardiac syncope, and possibly also other syncope aetiologies exhibit circadian, weekly, seasonal, and temperature-dependent patterns.Methods and results We prospectively recorded the exact time, date, and outside temperature of syncope of patients > 40 years old presenting with syncope to the emergency department in a diagnostic multicentre study. Two independent cardiologists/emergency physicians adjudicated the final diagnosis based on all information becoming available during clinical work-up including 1-year follow-up. Among 1230 patients, the adjudicated aetiology was cardiac in 14.6%, reflex in 39.2%, orthostatic in 25.7%, other non-cardiac in 9.7%, and unknown in 10.8% of patients. All syncope aetiologies occurred much more frequently during the day when compared with the night (P < 0.01). While reflex and orthostatic syncope showed a broad peak of prevalence with 80.9% of these events occurring between 4 am and 4 pm, cardiac syncope showed a narrow peak of prevalence with 70.1% of all events occurring between 8 am and 2 pm. A weekly pattern was present for most syncope aetiologies, with events occurring mainly from Monday to Friday (P < 0.01). Reflex syncope displayed a seasonal rhythm and was more common in winter (P < 0.01), while cardiac syncope stayed constant over the year. Syncope occurred most often when the outside temperature was coldest. Overall the patterns observed for cardiac syncope were similar to the patterns observed for its differential diagnosis.Conclusion Syncope aetiologies in patients > 40 years old display circadian, weekly, seasonal, and temperature-dependent patterns. Unfortunately, these patterns do not allow to reliably differentiate cardiac syncope from other aetiologies.