Characteristics Of Syncope And The Predictive Value Of EGSYS Score For Cardiac Syncope In Children

Background and ObjectivesSyncope is one of the most common emergencies in children and adolescents.Cardiac syncope(CS)is always with high mortality,but it’s often misdiagnosed or missed diagnosis.Our study aimed to analyze the clinical characteristics of syncope in children,and to assess the predictive value of "the Evaluation of Guidelines in Syncope Study(EGSYS)" score for the diagnosis of CS in children.Methods1.Children with neurally mediated syncope(NMS),cardiac syncope(CS),and unexplained syncope(US)from January 2009 to December 2021,were admitted to Qilu Hospital of Shandong University.The medical history,physical examination,supplementary examination and other clinical data were collected and analyzed,retrospectively.2.To calculate the EGSYS scores of children with NMS and CS,and explore the predictive value of EGSYS for the diagnosis of CS with the receiver operating characteristic(ROC)curve and Hosmer-Lemeshow goodness-of-fit test.Results1.Disease distribution of included patients:Among 373 children,281 cases(75.3%) were diagnosed as NMS,which included 176 cases(62.6%)of Vasovagal Syncope(VVS),26 cases(9.3%)of Postural tachycardia syndrome(POTS),75 cases(26.7%)of VVS and POTS,3 cases(1.1%)of orthostatic hypertension,and a case(0.4%)of orthostatic hypotension.51 cases(13.7%)were diagnosed as CS,which included 27 cases(52.9%)with arrhythmia,9 cases(1 7.6%)with structural cardiovascular disease,and 15 cases(29.4%)with both causes.2.Comparison of clinical characteristics of CS,NMS,and US groups:(1)There was a statistically significant difference in the following clinical factors between CS and NMS groups(P<0.05):the precipitating factors including exercise,prolonged standing,change in position and special situations;the prodromes including sweating,pale,gastrointestinal symptoms,and blurred vision;syncope in the supine position;the accompanying symptoms including convulsions and fecal incontinence;a history of cardiovascular disease and abnormal findings in physical examination.(2)There was a statistically significant difference in the following clinical factors between CS and US groups(P<0.05):the precipitating factors including exercise and prolonged standing;the prodromes including sweating,gastrointestinal symptoms,blurred vision,pale,chest tightness;the accompanying symptoms including convulsions and fecal incontinence;a history of cardiovascular disease;abnormal findings in physical examination.(3)There was a statistically significant difference in the following clinical factors between NMS and US groups(P<0.05):special situations and chest tightness before syncope.(4)There was no statistically signifi cant difference in disease course,occurring frequency,duration of loss of consciousness,and a family history of sudden death or syncope among three groups(P>0.05).3.Supplementary examination results:There were 48 cases(48/51,94.1%)of CS,30 cases(30/269,11.2%)of NMS,and 2 cases(2/41,4.9%)of US with abnormal results among those completed 12-lead electrocardiogram(ECG)examination.There were 31 cases(31/36,86.1%)of CS,23 cases(23/180,12.8%)of NMS,and 5 cases(5/29,17.2%)of US with abnormal results of Dynamic Electrocardiography(DCG)examination.Among those who conducted echocardiography,28 cases(28/50,56.0%)of CS,34(34/235,14.5%)cases of NMS,and 5 cases(5/33,15.2%)of US had abnormal results.3 cases of CS and 58 cases of NMS completed the coronary CTA examination,and myocardial bridge was detected in 26 cases while anomalous origin of coronary artery in 2 cases.4.Genetic testing results:11 cases with CS underwent genetic test,and 9 of them were detected with pathogenic mutation.Of those,4 cases were diagnosed as catecholaminergic polymorphic ventricular tachycardia(CPVT),3 cases suffered from long QT syndrome(LQTS)and 2 cases were idiopathic pulmonary hypertension(IPAH).5.EGSYS evaluation scores results:There were 4 variables with statistically significant difference between CS and NMS groups(P<0.05),including abnormal ECG/heart diseases,effort syncope,the supine position,autonomic nervous prodromes,while 2 variables including palpitations and predisposing factors had no statistical difference.The median ECSYS scores of CS and NMS groups were 4(3,5)and-1(-2,1)respectively.And there were a statistical significance in the EGSYS scores between two groups(P<0.05).Area under the ROC curve(AUC)was 0.922(95%CI 0.892-0.952,P<0.001).Hosmer-Lemeshow test demonstrated satisfactory calibration of the model(X2=1.468,P=0.917).When the score was≥3,the sensitivity and specificity of the diagnosis of CS were 0.843(95%Cl 0.709-0.925)and 0.879(95%CI 0.834-0.914)respectively.Conclusions1.A detail medical history and physical examination can help to identify different typesof syncope.2.Genetic test is of great significance for the diagnostic of CS caused by hereditary cardiovascular disease.3.EGSYS score can be used to distinguish CS from NMS.When EGSYS score was≥3,it is more likely to be diagnosed as CS.