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. 2023 Nov 21;23(1):576.
doi: 10.1186/s12872-023-03615-y.

Brain MRI and EEG overemployment in patients with vasovagal syncope: results from a tertiary syncope unit

Masih Tajdini  1   2 , Amirmohammad Khalaji  3   4   5 , Amir Hossein Behnoush  1   2   6 , Hamed Tavolinejad  1   2 , Arash Jalali  2   7 , Saeed Sadeghian  1   2 , Ali Vasheghani-Farahani  1   2 , Somayeh Yadangi  1   2 , Farzad Masoudkabir  1   2 , Ali Bozorgi  1   2
Affiliations

Brain MRI and EEG overemployment in patients with vasovagal syncope: results from a tertiary syncope unit

Masih Tajdini et al. BMC Cardiovasc Disord. .

Abstract

Background: The diagnosis of vasovagal syncope (VVS) is mainly based on history-taking and physical examination. However, brain Magnetic Resonance Imaging (MRI) and Electroencephalogram (EEG) are commonly used in the diagnostic course of VVS, despite not being indicated in the guidelines. This study aims to find the possible associated factors with the administration of brain MRI and EEG in patients with VVS.

Methods: Patients with a diagnosis of VVS from 2017 to 2022 were included. Several demographic and syncope features were recorded. The association of these was assessed with undergoing MRI, EEG, and either MRI or EEG. Univariate and multivariable logistic regression models were also used to calculate odds ratios (OR) and 95% confidence intervals (CI).

Results: A total of 1882 patients with VVS were analyzed, among which 810 underwent MRI (43.04%), 985 underwent EEG (52.34%), and 1166 underwent MRI or EEG (61.96%). Head trauma (OR 1.38, 95% CI 1.06 to 1.80), previous neurologist visit (OR 6.28, 95% CI 4.24 to 9.64), and gaze disturbance during syncope (OR 1.75, 95% CI 1.13 to 2.78) were all positively associated to the performance of brain MRI/EEG. Similar results were found for urinary incontinence (OR 2.415, 95% CI 1.494 to 4.055), amnesia (OR 1.421, 95% CI 1.053 to 1.930), headache after syncope (OR 1.321, 95% CI 1.046 to 1.672), and tonic-clonic movements in head-up tilt table test (OR 1.501, 95% CI 1.087 to 2.093). However, male sex (OR 0.655, 95% CI 0.535 to 0.800) and chest pain before syncope (OR 0.628, 95% CI 0.459 to 0.860) had significant negative associations with performing brain MRI/EEG.

Conclusion: Based on our findings, performing MRI or EEG was common among VVS patients while it is not indicated in the majority of cases. This should be taken into consideration to prevent inappropriate MRI/EEG when there is a typical history compatible with VVS.

Keywords: Diagnosis; Electroencephalography; Magnetic resonance imaging; Neurologic examination; Vasovagal syncope.

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Conflict of interest statement

None declared.

Figures

Fig. 1
Fig. 1
Associations between clinical features of patients with VVS and previous (A) brain MRI (unadjusted), (B) brain MRI (adjusted), (C) EEG (unadjusted), (D) EEG (adjusted), (E) brain MRI or EEG (unadjusted), and (F) brain MRI or EEG (adjusted)
Fig. 2
Fig. 2
Receiver operating characteristic curve discriminating patients with previous brain MRI or EEG from those without previous brain MRI or EEG
See this image and copyright information in PMC

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