CT Heart Function and Morphology There is no relevant literature that examines the use of ECG-gated CT heart in this clinical scenario. CT heart can identify hypertrophic cardiomyopathy and thrombus in the cardiac chambers. CTA Coronary Arteries One small retrospective study found that patients with cardiac-related syncope or presyncope had a greater extent and severity of coronary artery disease by coronary CTA (CCTA) compared with those with noncardiac-related syncope and matched patients with chest pain and no syncope [48]. Additionally, anomalous coronary arteries can be a cause of exercise-induced syncope or presyncope, especially in younger patients [49,50]. However, there are no prospective or large retrospective studies assessing the utility of CCTA in patients with syncope or presyncope as the only presenting finding. MRI Head There is no relevant literature to support the use of head MRI in this clinical scenario. MRI Heart Function and Morphology There is no relevant literature that examines the use of cardiac MRI in this clinical scenario. MRI heart can provide detailed analysis of cardiac function, morphology, and physiology. MRI is a valuable tool in the diagnosis of infiltrative cardiomyopathies that can manifest with episodes of syncope and presyncope including hypertrophic cardiomyopathy [51,52], sarcoid [53,54], myocarditis [55-57], amyloid [58], arrhythmogenic right ventricular dysplasia [58], and nonischemic dilated cardiomyopathy [58,59]. In both ischemic and nonischemic cardiomyopathies, MRI can assess for areas of scarring, which can serve as an arrhythmogenic focus and can lead to syncope or sudden cardiac death [60]. Although not routinely utilized as an initial imaging tool, cardiac MRI could be utilized in stable patients as an alternative to echocardiography when image quality is not diagnostic or optimal. Radiography Chest There are no prospective studies that examine the use of chest radiographs in patients with syncope or presyncope.
Syncope. CT Heart Function and Morphology There is no relevant literature that examines the use of ECG-gated CT heart in this clinical scenario. CT heart can identify hypertrophic cardiomyopathy and thrombus in the cardiac chambers. CTA Coronary Arteries One small retrospective study found that patients with cardiac-related syncope or presyncope had a greater extent and severity of coronary artery disease by coronary CTA (CCTA) compared with those with noncardiac-related syncope and matched patients with chest pain and no syncope [48]. Additionally, anomalous coronary arteries can be a cause of exercise-induced syncope or presyncope, especially in younger patients [49,50]. However, there are no prospective or large retrospective studies assessing the utility of CCTA in patients with syncope or presyncope as the only presenting finding. MRI Head There is no relevant literature to support the use of head MRI in this clinical scenario. MRI Heart Function and Morphology There is no relevant literature that examines the use of cardiac MRI in this clinical scenario. MRI heart can provide detailed analysis of cardiac function, morphology, and physiology. MRI is a valuable tool in the diagnosis of infiltrative cardiomyopathies that can manifest with episodes of syncope and presyncope including hypertrophic cardiomyopathy [51,52], sarcoid [53,54], myocarditis [55-57], amyloid [58], arrhythmogenic right ventricular dysplasia [58], and nonischemic dilated cardiomyopathy [58,59]. In both ischemic and nonischemic cardiomyopathies, MRI can assess for areas of scarring, which can serve as an arrhythmogenic focus and can lead to syncope or sudden cardiac death [60]. Although not routinely utilized as an initial imaging tool, cardiac MRI could be utilized in stable patients as an alternative to echocardiography when image quality is not diagnostic or optimal. Radiography Chest There are no prospective studies that examine the use of chest radiographs in patients with syncope or presyncope.