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European Heart Journal Advance Access originally published online on October 13, 2005
European Heart Journal 2006 27(3):344-350; doi:10.1093/eurheartj/ehi584
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Diagnostic criteria for vasovagal syncope based on a quantitative history

Robert Sheldon1,*, Sarah Rose1, Stuart Connolly2, Debbie Ritchie1, Mary-Lou Koshman1, Michael Frenneaux3 for the Syncope Symptom Study Investigators{dagger}

1Cardiovascular Research Group, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N2, Canada
2McMaster University, Hamilton, Ontario, Canada
3Wales Heart Institute, Cardiff, Wales, UK

Received 7 June 2005; revised 18 August 2005; accepted 22 September 2005; online publish-ahead-of-print 13 October 2005.

* Corresponding author. Tel: +403 220 8191; fax:+403 270 0313. E-mail address: sheldon{at}ucalgary.ca

See page 253 for the editorial comment on this article (doi:10.1093/eurheartj/ehi663)

Aims Our goal was to develop historical criteria for the diagnosis of vasovagal syncope.

Methods and results We administered a 118-item historical questionnaire to 418 patients with syncope and no apparent structural heart disease. The prevalence of each item was compared between patients with positive tilt tests and those with syncope of other, known causes. The contributions of symptoms to diagnoses were estimated with logistic regression, point scores were developed, and the scores were tested using receiver operator characteristic analysis. The accuracy of the decision rule was assessed with bootstrapping. Data sets were complete for all subjects. The causes of syncope were known in 323 patients and included tilt-positive vasovagal syncope (235 patients) and other diagnoses such as complete heart block and supraventricular tachycardias (88 patients). The point score correctly classified 90% of patients, diagnosing vasovagal syncope with 89% sensitivity and 91% specificity. The decision rule suggested that 68% of an additional 95 patients with syncope of unknown cause and a negative tilt test have vasovagal syncope.

Conclusion A simple point score of historical features distinguishes vasovagal syncope from syncope of other causes with very high sensitivity and specificity.

Key Words: Vasovagal • Syncope • Diagnosis • Tilt test • Faint • Point scores • History


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