[Prognosis of presyncope in patients with structural heart disease]

Introduction and objectives Few data are available on the prognosis of presyncope in patients with structural heart disease. The aim of this study was to compare the clinical characteristics and long-term prognosis of patients with structural heart disease admitted for presyncope or syncope in the cardiology department of a tertiary hospital. Methods We reviewed the medical records of 449 patients (65% men, mean age 66.8 [13.1] years) with structural heart disease admitted because of syncope (n = 272) or presyncope (n = 177) during the period from 1992 to 1998. Clinical and demographic variables were analyzed and the final diagnosis was classified according to European Society of Cardiology criteria. The follow-up (available in 97.1% of patients) consisted of a personal interview with the patient or a review of the medical records and an interview with the relatives of the patients who had died. Results Both groups had similar demographic and clinical characteristics, except for the presence of atrial fibrillation on admission, which was more common in the presyncope group. Previous syncopal episodes were more frequent in patients admitted for syncope. The mechanism of the episode was considered arrhythmic in 25.7% of the patients with syncope and 22.0% of those in the presyncope group (P = .37). After a mean follow-up of 57.4 [30.5 months the survival curves were similar for both groups and no significant differences were found regarding the causes of death or the rate of sudden death. Conclusions The clinical characteristics and the long-term prognosis in patients with structural heart disease admitted to a cardiology department for presyncope are similar to those of patients admitted for syncope. This suggests that the approach to diagnosis and risk stratification should be similar in both groups of patients.