Diagnostic Yield of Echocardiography in Syncope Patients with Normal ECG
Table 2
Echocardiographic findings in patients with abnormal TTE in both normal and abnormal ECG groups.
TTE findings
Discharge diagnosis
Echo useful in diagnosis of syncope?
Normal ECG with abnormal TTE ()
Moderate-severe aortic stenosis with mild aortic insufficiency
Orthostatic hypotension
No
Severe aortic stenosis
Multifactorial nonspecific cause
No
Severe aortic stenosis. Normal LV function with EF 55–60%. Mild concentric LVH.
Undetermined cause
No
Right atrial enlargement. Right ventricular hypertrophy. Severe tricuspid regurgitation. Mild mitral regurgitation.
Orthostatic hypotension
No
LVEF 35–40% with grade I diastolic dysfunction
Unknown
No
Estimated left ventricular ejection fraction of 40%. Mild mitral regurgitation.
Unknown
No
LVEF 40% diffuse hypokinesis
Unknown
No
LV cardiomyopathy, LVEF 35–40%
Unknown
No
Moderate global hypokinesis of the left ventricle with ejection fraction 35%. Tricuspid regurgitation
Unknown
No
Moderate LV dysfunction with EF 40% and diffuse hypokinesis. Aortic root calcification.
Vasovagal response
No
Mild dilated LV with reduced systolic function. EF 35%. Moderate global hypokinesis.
Vasovagal response
No
Abnormal ECG with abnormal TTE ()
Mild mitral valve prolapse. Concentric LVH. Septal hypokinesis. Moderate left atrial enlargement. Severe pulmonary hypertension.
Severe pulmonary hypertension
Yes
Severe MR, severe TR
Orthostatic hypotension
No
Patient in atrial fibrillation rhythm. Moderate hypokinesis of the LVEF 35–40%.
Unknown
No
LVEF 40%
Atrial flutter with RVR
No
Mildly dilated left ventricle with severely reduced systolic function and LVEF of 25–30%. Moderate concentric left ventricular hypertrophy.
Unknown
No
LVEF of 40–45%. Akinesis of the anterior septum and inferior septum. Trace MR and TR.
Vasovagal response
No
LV enlargement. Generalized hypokinesis. EF ~25%.
Unknown
No
LVEF 30%. Diffuse hypokinesis
Acute HF exacerbation with respiratory failure
No
Moderate AI and TR. LVEF 30%, LVH
Carotid hypersensitivity
No
LV enlargement with generalized hypokinesis and EF 25–30%
Unknown
No
Moderate LA enlargement. Moderate-severe MR.
Unknown
No
Dilated LV with EF ~25%
Unknown
No
Marked anteroapical hypokinesis with LVEF ~30%. Mild-Moderate AI.
Unknown
No
LVH. Normal EF. Large significant pericardial effusion.
Large pericardial effusion
Yes
LVEF 30%. LVH.
Vasovagal response
No
LVEF 30% with diffuse hypokinesis.
Vasovagal response
No
LV enlargement with generalized hypokinesis. EF 25–30%
Ventricular fibrillation status after ICD shock
No
Generalized hypokinesis. Paradoxical septal motion. LVEF 25%, MR and TR
Paradoxical septal motion
Yes
Left ventricular hypertrophy. Paradoxical motion of interventricular septum with preserved LV systolic function. Mild to moderate tricuspid insufficiency
Sinus bradycardia secondary to medication overdose
No
LVEF severely reduced and estimated at 25%. Severe global hypokinesis of the left ventricle. The entire inferior wall is akinetic. Impaired left ventricular relaxation. Severe mitral regurgitation.
Unknown
No
Severe aortic stenosis. LVEF normal.
Severe aortic stenosis
Yes
Asymmetrical septal hypertrophy of the left ventricle. Associated moderate left ventricular outflow tract gradient of 30 mmHg. Associated “pseudo-SAM” with no true systolic anterior motion of the mitral valve noted. Grade II left ventricular diastolic dysfunction.
HOCM
Yes
Severe left ventricular dysfunction. Moderately severe to severe mitral regurgitation.
Severe conduction disease
No
LVEF of 30%. Mild MR. Mild to moderate TR. Anteroapical hypokinesis and septal akinesis.
Acute HF exacerbation with respiratory insufficiency
No
Dilated LV with EF 35%. Moderate global hypokinesis
Vasovagal response
No
LVEF 35%. Inferior hypokinesis
Unknown
No
LVEF of 35–45%. Findings compatible with pericardial effusion with right atrial cyclic compression.
Significant pericardial effusion
Yes
LVEF, left ventricular ejection fraction. AI, aortic insufficiency. MR, mitral regurgitation. TR, tricuspid regurgitation. LVH, left ventricular hypertrophy. Previously documented AS on prior echo and hospital records.
