Cardiac imaging in patients with cardiac syncope

Syncope is a common symptom with a possibly unfavorable prognosis, especially when the cause is a cardiac disease. Often diagnostic workup requires multiple and challenging investigations to determine whether the patient has a structural heart disease. Cardiac imaging tests should be used when baseline clinical findings raise the suspicion of a cardiac syncope. Transthoracic echocardiography is the first line imaging examination as it helps establish the cause of syncope and supplies useful information for prognostic stratification by evaluating systolic ventricle function. Advanced imaging techniques such as multidetector computed tomography and cardiac magnetic resonance imaging should be reserved for selected cases when echocardiography is inconclusive. With this review we aim to report the main information obtainable with cardiac imaging tests in patients with suspected or known cardiac syncope. We summarize the most common as well as rarer heart structural diseases which may cause syncope and briefly state the possible physio-pathologic mechanism. For each heart disease we describe the role of the various imaging techniques and the possible diagnostic and prognostic information provided by these techniques.