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High-risk features and predictors of unexplained syncope in the young SCD-SOS cohort

Carrington, M; Pais, J; Brás, D; Creta, A; Teixeira, R; Gonçalves, L; Providência, R; (2021) High-risk features and predictors of unexplained syncope in the young SCD-SOS cohort. Journal of Cardiovascular Electrophysiology , 32 (10) pp. 2737-2745. 10.1111/jce.15204. Green open access

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Abstract

Introduction: The Sudden Cardiac Death-Screening of Risk FactOrS survey included a 12-lead ECG plus a digital-based questionnaire and aimed to screen for warning signs of diseases that may course with sudden cardiac death in children and young adults. We aimed to estimate the prevalence of unexplained syncope (US) and characterize its high-risk features and predictors in this cohort. // Methods &Results: We determined the most probable etiology of transient loss of consciousness (TLOC) episodes based on clinical criteria. US was an exclusion diagnosis and we analyzed its potential clinical and ECG predictors. Among 11,878 individuals, with a mean age of 21±6 (range 6-40) years-old, the cumulative incidence of TLOC was 26.5%, 76.2% corresponding to females. Reflex syncope was present in 66.4%, orthostatic hypotension in 8.2% and 14.8% of the individuals had US. Unexplained syncope was independently associated with age <18years-old (OR 1.695; 95%CI 1.26-2.29,p=0.001), male gender (OR 1.642; 95%CI 1.22-2.22,p=0.001), participation in competitive sports (OR 1.644;95%CI 1.01-2.66,p=0.043), syncope during exertion and/or palpitations preceding syncope (OR 2.556; 95%CI 1.92-3.40,p<0.001), syncope after exertion (OR 2.662; 95%CI 1.73-4.10,p<0.001), fever context (OR 9.606; 95%CI 4.13-22.34,p<0.001), isolated previous syncopal episode (OR 2.780; 95%CI 0.2.06-3.75,p<0.001) and history of palpitations requiring medical care (OR 1.945; 95%CI 1.14-3.31,p=0.014). We found no ECG predictors of US in this population. // Conclusions: The cumulative incidence of TLOC in children and young adults is high and remains unexplained in an important proportion of individuals. We identified eight clinical characteristics that may be useful for the risk stratification of individuals evaluated in a non-acute setting.

Type: Article
Title: High-risk features and predictors of unexplained syncope in the young SCD-SOS cohort
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/jce.15204
Publisher version: https://doi.org/10.1111/jce.15204
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher's terms and conditions.
Keywords: athletes, children and young adults, predictors, transient loss of consciousness, unexplained syncope
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics
URI: https://discovery.ucl.ac.uk/id/eprint/10133128
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