P451 PREDICTIVE VALUE OF INITIAL ASSESSMENT IN IDENTIFYING SYNCOPE TYPE (HYPOTENSIVE/BRADYCARDIA)

Abstract

Abstract Introduction Syncope manifests itself according to two main mechanisms: the hypotensive phenotype, in which the prevalent mechanism is represented by the reduction of blood pressure values, and the bradycardia phenotype, in which the reduction in heart rate prevails. The Tilt–Test plays an important role in the diagnosis and study of syncope. The request for tilt–test execution in the last 2 years has progressively increased, also in consideration of the closure of the syncope units present in peripheral hospitals and the covid–19 pandemic. The requests for tilt execution did not always appear to be appropriate or, in any case, the diagnosis emerged already evident at the initial evaluation. The purpose of the study is to evaluate the diagnostic value of the initial evaluation in identifying the type of syncope starting from the bradycardia/hypotensive phenotype, in order to select the patients who need to perform the examination. Methods The procedure followed by our center for all patients referring to the syncope unit consists in carrying out an initial evaluation, the clinical evaluation of the patient according to the GIMSI protocol, carrying out the head–up tilt test and carotid sinus massage, and, in certain patients, loop recorder implantation. In this study, the initial evaluations of 58 patients who underwent the tilt test were considered, making an assessment of the phenotype of each, which was subsequently compared with the actual result of the test. Results The evaluation parameters chosen were: the presence and type of syncope and prodromes before the test, traumatic and/or driving syncope, blood pressure and baseline heart rate. The patients who at the initial evaluation presented a hypotensive phenotype were 23, those with a bradycardia phenotype 24, while those with a mixed phenotype 11. We then went on to consider the results of the test performed, evaluated on the basis of the VASIS classification. From the data comparison we had a correlation of the phenotype in 72% of the patients, while in 28% it was not possible to predict the phenotype. Conclusions Through these data we can therefore see how the initial evaluation allows early identification of the type of syncope in 72% of patients, selecting the patients who actually need the examination to be performed, in the face of an ever–increasing request.