In one large retrospective multi-institution study evaluating syncope and presyncope in 3,686 patients >60 years of age, 2,767 (75.1%) had a chest radiograph performed [61]. Of those, 182 (6.6%), had a radiograph interpreted as abnormal. In a smaller retrospective study performed at a single institution, only 4.5% of patients with syncope had an abnormal chest radiograph. However, patients with syncope or presyncope who had abnormal chest radiographs were more likely to have serious adverse events compared with those with normal radiographs [62]. SPECT or SPECT/CT MPI Rest and Stress There is no relevant literature to support the routine use of a Tc-99m SPECT or SPECT/CT MPI rest and stress in most patients with syncope. Limited data from one large retrospective study assessing the use of MPI in 700 patients with syncope of any cause and no known coronary artery disease concluded there was no significant utility for testing [63]. SPECT or SPECT/CT MPI Rest Only There is no relevant literature that examines the use of Tc-99m SPECT or SPECT/CT MPI rest only study in this clinical scenario. SPECT or SPECT/CT MPI Stress Only There is no relevant literature that examines the use of Tc-99m SPECT or SPECT/CT MPI stress only study in this clinical scenario. US Duplex Doppler Carotid Artery Multiple studies have shown no benefit of carotid artery Doppler US in patients with syncope or presyncope in the absence of neurologic findings or carotid bruit [20,64-66]. US Echocardiography Transesophageal There is no relevant literature that examines the use of transesophageal echocardiography in this clinical scenario. sSecac US Echocardiography Transthoracic Resting There is no relevant literature that examines the use of transthoracic resting echocardiography in this clinical scenario, especially if a patient who has syncope or presyncope in the setting of a normal ECG and low probability of a cardiac cause of symptoms [66,69,72,73].
Syncope. In one large retrospective multi-institution study evaluating syncope and presyncope in 3,686 patients >60 years of age, 2,767 (75.1%) had a chest radiograph performed [61]. Of those, 182 (6.6%), had a radiograph interpreted as abnormal. In a smaller retrospective study performed at a single institution, only 4.5% of patients with syncope had an abnormal chest radiograph. However, patients with syncope or presyncope who had abnormal chest radiographs were more likely to have serious adverse events compared with those with normal radiographs [62]. SPECT or SPECT/CT MPI Rest and Stress There is no relevant literature to support the routine use of a Tc-99m SPECT or SPECT/CT MPI rest and stress in most patients with syncope. Limited data from one large retrospective study assessing the use of MPI in 700 patients with syncope of any cause and no known coronary artery disease concluded there was no significant utility for testing [63]. SPECT or SPECT/CT MPI Rest Only There is no relevant literature that examines the use of Tc-99m SPECT or SPECT/CT MPI rest only study in this clinical scenario. SPECT or SPECT/CT MPI Stress Only There is no relevant literature that examines the use of Tc-99m SPECT or SPECT/CT MPI stress only study in this clinical scenario. US Duplex Doppler Carotid Artery Multiple studies have shown no benefit of carotid artery Doppler US in patients with syncope or presyncope in the absence of neurologic findings or carotid bruit [20,64-66]. US Echocardiography Transesophageal There is no relevant literature that examines the use of transesophageal echocardiography in this clinical scenario. sSecac US Echocardiography Transthoracic Resting There is no relevant literature that examines the use of transthoracic resting echocardiography in this clinical scenario, especially if a patient who has syncope or presyncope in the setting of a normal ECG and low probability of a cardiac cause of symptoms [66,69,72,73].