ALERT-CS - Development of an ECG-based cardiac syncope ... .pdf · §15 recruitment centers in 9...
Transcript of ALERT-CS - Development of an ECG-based cardiac syncope ... .pdf · §15 recruitment centers in 9...
![Page 1: ALERT-CS - Development of an ECG-based cardiac syncope ... .pdf · §15 recruitment centers in 9 countries on 4 continents §> 3000 patients recruited BAsel Syncope EvaLuation (BASEL](https://reader030.fdocuments.us/reader030/viewer/2022011906/5f433a3dc580d764c00ed821/html5/thumbnails/1.jpg)
Tobias Zimmermann, MDESC Congress, Paris (FR)Sept 1st, 2019
ALERT-CS – Development and validation of an ECG-based cardiac syncope risk calculator
![Page 2: ALERT-CS - Development of an ECG-based cardiac syncope ... .pdf · §15 recruitment centers in 9 countries on 4 continents §> 3000 patients recruited BAsel Syncope EvaLuation (BASEL](https://reader030.fdocuments.us/reader030/viewer/2022011906/5f433a3dc580d764c00ed821/html5/thumbnails/2.jpg)
Icons by Freepik from www.flaticon.com
Disclosures
![Page 3: ALERT-CS - Development of an ECG-based cardiac syncope ... .pdf · §15 recruitment centers in 9 countries on 4 continents §> 3000 patients recruited BAsel Syncope EvaLuation (BASEL](https://reader030.fdocuments.us/reader030/viewer/2022011906/5f433a3dc580d764c00ed821/html5/thumbnails/3.jpg)
Introduction
1-2% of all ED visits50% discharged w/ unknown syncope
![Page 4: ALERT-CS - Development of an ECG-based cardiac syncope ... .pdf · §15 recruitment centers in 9 countries on 4 continents §> 3000 patients recruited BAsel Syncope EvaLuation (BASEL](https://reader030.fdocuments.us/reader030/viewer/2022011906/5f433a3dc580d764c00ed821/html5/thumbnails/4.jpg)
Introduction
1-2% of all ED visits50% discharged w/ unknown syncope
15% cardiac syncope
30% mortality per year
![Page 5: ALERT-CS - Development of an ECG-based cardiac syncope ... .pdf · §15 recruitment centers in 9 countries on 4 continents §> 3000 patients recruited BAsel Syncope EvaLuation (BASEL](https://reader030.fdocuments.us/reader030/viewer/2022011906/5f433a3dc580d764c00ed821/html5/thumbnails/5.jpg)
§ Aim: To improve the early diagnosis of cardiac syncope and enhance the management of patients with syncope on the Emergency Department.
§ Definition of cardiac syncope: Tachy- / bradyarrhythmia, severe structural heart disease, congenital anomaly, aortic dissection or pulmonary hypertension leading to a transient loss of consciousness.
§ Prospective international diagnostic multicenter study§ 15 recruitment centers in 9 countries on 4 continents§ > 3000 patients recruited
BAsel Syncope EvaLuation (BASEL IX) study
![Page 6: ALERT-CS - Development of an ECG-based cardiac syncope ... .pdf · §15 recruitment centers in 9 countries on 4 continents §> 3000 patients recruited BAsel Syncope EvaLuation (BASEL](https://reader030.fdocuments.us/reader030/viewer/2022011906/5f433a3dc580d764c00ed821/html5/thumbnails/6.jpg)
BAsel Syncope EvaLuation (BASEL IX) study
Standardized recordings
12-lead ECGLarge biobank
Long-term follow-upDiagnostic adjudication
![Page 7: ALERT-CS - Development of an ECG-based cardiac syncope ... .pdf · §15 recruitment centers in 9 countries on 4 continents §> 3000 patients recruited BAsel Syncope EvaLuation (BASEL](https://reader030.fdocuments.us/reader030/viewer/2022011906/5f433a3dc580d764c00ed821/html5/thumbnails/7.jpg)
BAsel Syncope EvaLuation (BASEL IX) study
Standardized recordings
12-lead ECGLarge biobank
Long-term follow-upDiagnostic adjudication
![Page 8: ALERT-CS - Development of an ECG-based cardiac syncope ... .pdf · §15 recruitment centers in 9 countries on 4 continents §> 3000 patients recruited BAsel Syncope EvaLuation (BASEL](https://reader030.fdocuments.us/reader030/viewer/2022011906/5f433a3dc580d764c00ed821/html5/thumbnails/8.jpg)
Penalized stepwise backward selection
13 7
QRS axis
Bundle branch block
ST-depression
ST-elevation
Q-wave T-wave inversion
Rhythm
QTc-interval
Heart rate
AV-block
LVH
Ventricular ES/nsVT
QRS interval
Bundle branch block
ST-depression
Rhythm
AV-block
Ventricular ES/nsVT
QTc-intervalHeart rate
categorical continuous
8
![Page 9: ALERT-CS - Development of an ECG-based cardiac syncope ... .pdf · §15 recruitment centers in 9 countries on 4 continents §> 3000 patients recruited BAsel Syncope EvaLuation (BASEL](https://reader030.fdocuments.us/reader030/viewer/2022011906/5f433a3dc580d764c00ed821/html5/thumbnails/9.jpg)
§ Good diagnostic discrimination (AUC 0.80, 95%-CI 0.77 to 0.83)
§ Good internal calibration(bootstrapped, 1000x)
Diagnostic performance
9
![Page 10: ALERT-CS - Development of an ECG-based cardiac syncope ... .pdf · §15 recruitment centers in 9 countries on 4 continents §> 3000 patients recruited BAsel Syncope EvaLuation (BASEL](https://reader030.fdocuments.us/reader030/viewer/2022011906/5f433a3dc580d764c00ed821/html5/thumbnails/10.jpg)
Prognostic performance
10
![Page 11: ALERT-CS - Development of an ECG-based cardiac syncope ... .pdf · §15 recruitment centers in 9 countries on 4 continents §> 3000 patients recruited BAsel Syncope EvaLuation (BASEL](https://reader030.fdocuments.us/reader030/viewer/2022011906/5f433a3dc580d764c00ed821/html5/thumbnails/11.jpg)
§ Prognostic performance at 30d:
§ Slightly worse for overall and arrhythmic MACE(AUC 0.70, 95%-CI 0.65 - 0.74, AUC 0.72, 95%-CI 0.67 - 0.78)
§ Very similar for death(AUC 0.64, 95%-CI 0.53 - 0.75)
Prognostic external validation – SRS study (USA)
11
![Page 12: ALERT-CS - Development of an ECG-based cardiac syncope ... .pdf · §15 recruitment centers in 9 countries on 4 continents §> 3000 patients recruited BAsel Syncope EvaLuation (BASEL](https://reader030.fdocuments.us/reader030/viewer/2022011906/5f433a3dc580d764c00ed821/html5/thumbnails/12.jpg)
§ Only patients in the ED, unclear if applicable to patients in primary care
§ ECG interpretation, inter-interpreter variability
§ Diagnostic adjudication, not 100% perfect
Limitations
12
![Page 13: ALERT-CS - Development of an ECG-based cardiac syncope ... .pdf · §15 recruitment centers in 9 countries on 4 continents §> 3000 patients recruited BAsel Syncope EvaLuation (BASEL](https://reader030.fdocuments.us/reader030/viewer/2022011906/5f433a3dc580d764c00ed821/html5/thumbnails/13.jpg)
ALERT-CS - Conclusion
§ Fast, cheap, easy-to-use tool to identify patients at high risk for cardiac syncope (No rule-out tool!)
§ Complements other currently available tools like biomarkers and medical history
13