Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access
Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc
Journal website https://www.cardiologyres.org

Original Article

Volume 9, Number 4, August 2018, pages 197-203


Utilization of Echocardiogram, Carotid Ultrasound, and Cranial Imaging in the Inpatient Investigation of Syncope: Its Impact on the Diagnosis and the Patient’s Length of Hospitalization

Figure

Figure 1.
Figure 1. Interval plot of hospital length of stay (LOS) in correlation with number of imaging test ordered. LOS: length of stay. The pooled standard deviation was used to calculate the intervals.

Tables

Table 1. Baseline Characteristics, Comorbidities, and Home Medications of Patients Admitted for Syncope
 
N = 109(%)
Age68.74 ± 21.04 years
Male43 (39.44%)
Female66 (60.55%)
Race
  White72 (66.05%)
  Black18 (16.51%)
  Hispanic13 (11.92%)
  Asian4 (3.66%)
  Other2 (1.83%)
Common Comorbidities
  Hypertension69 (63.30%)
  Hyperlipidemia35 (32.11%)
  Coronary artery disease22 (20.18%)
  Hypothyroidism18 (16.82%)
  Diabetes mellitus17 (15.59%)
  Atrial fibrillation15 (16.51%)
  Anemia15 (13.76%)
  Cerebrovascular accident11 (10.09%)
  Chronic kidney disease11 (10.09%)
  Dementia11 (10.09%)
Common Medications
  Statin37 (33.94%)
  Antiplatelet37 (33.94%)
  Beta blocker36 (33.02%)
  Calcium channel blocker32 (29.35%)
  Multivitamins23 (21.10%)
  Angiotensin converting enzyme inhibitor22 (20.18%)
  Selective serotonin reuptake inhibitor20 (18.34%)
  Thyroid hormone19 (17.43%)
  Angiotensin receptor block15 (13.76%)
  Anticonvulsant13 (11.92%)

 

Table 2. Investigatory Studies Ordered and Performed for Patients Admitted for Syncope and Its Results
 
N = 109(%)
Orthostatic vital signs
  Done45 (41.28%)
    Positive23 (51.11%)
  Not done64 (58.71%)
Telemetry
  Ordered106 (97.24%)
    Normal sinus rhythm85 (80.18%)
    Sinus bradycardia14 (13.20%)
    Bundle branch block14 (13.20%)
    First degree atrioventricular block10 (9.43%)
    Atrial fibrillation/flutter7 (6.60%)
    Premature atrial contraction3 (2.83%)
    Paced rhythm3 (2.83%)
    Nonsustained ventricular tachycardia3 (2.83%)
    Supraventricular tachycardia1 (0.94%)
    Sinus arrhythmia1 (0.94%)
    Sinus tachycardia1 (0.94%)
  Not ordered3 (2.83%)
Electrocardiogram
  Ordered106 (97.24%)
    Normal sinus rhythm73 (68.86%)
    Sinus bradycardia13 (12.26%)
    Right bundle branch block13 (12.26%)
    Nonspecific ST wave changes10 (9.43%)
    Left ventricular hypertrophy10 (9.43%)
    First degree atrioventricular block8 (7.54%)
    Premature atrial contraction7 (6.60%)
    Atrial fibrillation/flutter7 (6.60%)
    Sinus tachycardia6 (5.66%)
    Premature ventricular contraction6 (5.66%)
    Sinus arrhythmia5 (4.71%)
    Poor R wave progression5 (4.71%)
    Left bundle branch block4 (3.77%)
    Left anterior fascicular block4 (3.77%)
    Intraventricular conduction delay4 (3.77%)
    Lateral wall ischemia3 (2.83%)
    Left atrial enlargement2 (1.88%)
    Anterolateral wall ischemia1 (0.94%)
    Old inferior wall myocardial infarction1 (0.94%)
    Prolonged QT interval1 (0.94%)
  Not ordered3 (2.83%)
Electroencephalogram
  Ordered49 (44.95%)
    Negative47(95.91%)
    Positive2 (4.08%)
      Primary generalized epilepsy1 (50%)
      Left temporal region epilepsy1 (50%)
Nuclear stress test
  Ordered4 (3.66%)
    Positive0 (0%)
    Negative4 (100%)
Tilt table test
  Ordered3 (2.75%)
    Positive1 (33.33%)
    Negative2 (66.66%)
Intracardiac loop recorder placement
  Ordered5(4.58%)
Pacemaker interrogation
  Ordered2 (1.83%)
Electrophysiological studies
  Ordered0 (0%)

 

Table 3. Imaging Studies Ordered and Performed for Patients Admitted for Syncope and Its Results
 
N = 109(%)
ICA: internal carotid artery.
Cranial computed tomography
  Ordered83 (76.14%)
    Normal56 (67.46%)
    Microvascular disease17 (20.48%)
    Chronic basal ganglia infarct5 (6.02%)
    Hematoma2 (2.40%)
    Meningioma2 (2.40%)
    Chronic ischemic changes1 (1.20%)
    Central cortical atrophy1 (1.20%)
    Parenchymal volume loss1 (1.20%)
    Calcification1 (1.20%)
    Nonspecific white matter changes1 (1.20%)
    Small intraparenchymal hemorrhage1 (1.20%)
    Basal ganglia neuroepithelial cyst1 (1.20%)
    Cavernous malformation1 (1.20%)
    Hemorrhagic contusion1 (1.20%)
    Acute Maxillary sinusitis1 (1.20%)
  Not ordered26 (23.85%)
Carotid ultrasound
  Ordered36 (33.02%)
    Normal31 (86.11%)
    Proximal ICA bilateral stenosis (60-79%)1 (2.77%)
    Proximal ICA bilateral stenosis (40-59%)1 (2.77%)
    Right ICA stenosis (80-89%)1 (2.77%)
    Bilateral stenosis ICA (40-59%)1 (2.77%)
    Left ICA mild to moderate plaque1 (2.77%)
  Not ordered73 (66.97%)
Echocardiogram
  Ordered76 (69.72%)
    Diastolic dysfunction37 (46.68%)
    Concentric hypertrophy27 (35.52%)
    Normal14 (18.42%)
    Mild mitral regurgitation12 (15.78%)
    Mild tricuspid regurgitation9 (11.84%)
    Mitral annulus calcification8 (10.52%)
    Moderate to severe mitral regurgitation8 (10.52%)
    Mild Aortic regurgitation5 (6.57%)
    Moderate aortic regurgitation5 (6.57%)
    Moderate aortic stenosis5 (6.57%)
    Moderate tricuspid regurgitation5 (6.57%)
    Mild aortic stenosis4 (5.26%)
    Mild pulmonary hypertension4 (5.26%)
    Mild left ventricular hypertrophy4 (5.26%)
    Mild bilateral atrial enlargement4 (5.26%)
    Moderate pulmonary hypertension2 (2.63%)
    Severe right atrial enlargement2 (2.63%)
    Mild to moderate global hypokinesis2 (2.63%)
    Bioprosthetic valve2 (2.63%)
    Severe tricuspid regurgitation1 (1.31%)
    Speckled pattern1 (1.31%)
    Severe pulmonary hypertension1 (1.31%)
    Mild pericardial effusion1 (1.31%)
    Mild mitral stenosis1 (1.31%)
    Severe aortic stenosis1 (1.31%)
    Mild asymmetric hypertrophy1 (1.31%)
    Basal septum hypokinesis1 (1.31%)
    Mild aortic root dilation1 (1.31%)
    Mild basal septal hypertrophy1 (1.31%)
    Primum atrial septal defect1 (1.31%)
    Paramembranous ventricular septal defect1 (1.31%)
    Endocardial cushion defect1 (1.31%)
  Not ordered33 (30.27%)

 

Table 4. Number of Imaging Test Ordered for Patients Admitted for Syncope and Its Impact on the Hospital Length of Stay
 
N (%)Length of stay in days
No imaging test ordered9 (8.25%)2.22
One imaging test ordered27 (24.77%)2.44
Two imaging tests ordered46 (42.20%)2.58
Three imaging tests ordered27 (24.77%)3.07

 

Table 5. Number of Imaging Test Ordered (Echocardiogram, Carotid Ultrasound, and Cranial Computed Tomography) and Its Association to Patient’s Hospital Length of Stay
 
Hospital length of stay0 test (N = 9)1 test (N = 27)2 tests (N = 46)3 tests (N = 27)P (ANOVA)P (KW)
Mean ± SD2.222 ± 1.4812.444 ± 1.3962.587 ± 1.6273.074 ± 1.6390.368
Median(minimum - maximum)1 (1 - 4)2 (1 - 7)2 (1 - 6)3 (1 - 7)0.352

 

Table 6. Number of Imaging Test Ordered (Echocardiogram, Carotid Ultrasound, and Cranial Computed Tomography) and Its Influence on Admitting Diagnosis
 
Number of imaging test orderedSyncopeVasovagal syncopeSyncope vs. seizureTotal
Chi-square P value = 0.4165, nominal logistic regression P value = 0.939.
07 (8.092)1 (0.330)1 (0.578)9
122 (24.275)2 (0.991)3 (1.734)27
243 (41.358)1 (1.688)2 (2.954)46
326 (24.275)0 (0.991)1 (1.734)27
Total9847109

 

Table 7. Number of Imaging Test Ordered (Echocardiogram, Carotid Ultrasound, and Cranial Computed Tomography) and Its Influence on Discharge Diagnosis
 
Number of imaging test orderedSyncopeVasovagal syncopeNeurocardiogenic syncopeSyncope with seizureSyncope vs. seizureTotal
Chi-square P value = 0.1507; nominal logistic regression P value = 0.782.
08 (8.2569)0 (0.3303)0 (0.1651)0 (0.1651)1 (0.0826)9
123 (24.770)2 (0.9908)1 (0.4954)1 (0.4954)0(0.2477)27
243 (42.2018)2 (1.6881)0 (0.8440)1 (0.8440)0 (0.4220)46
326 (24.7706)0 (0.9908)1 (0.4954)0 (0.4954)0 (0.2477)27
Total1004221109

 

Table 8. Admitting and Discharge Diagnosis of Patients Admitted for Syncope
 
N = 109 (%)
Admitting diagnosis
  Syncope98 (89.90%)
  Syncope with fall7 (6.42%)
  Syncope vs. Seizure4 (3.66%)
Discharge diagnosis
  Syncope100 (91.74%)
  Vasovagal syncope4 (3.66%)
  Neurocardiogenic syncope2 (1.83%)
  Syncope with seizure2 (1.83%)
  Syncope vs. Seizure1 (0.91%)