Heart rate recovery and diastolic blood pressure ratio on the treadmill test predict an induction and recurrence of vasovagal syncope
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Background/Aims: The induction and recurrence of syncope is a concerning situation that could be unpredicted in the vasovagal syncope (VVS). We investigated a simple predictor for the induced and recurrent VVS during Head-Up table-tilt Test (HUT) and clinically follow-up. Methods: The 143 consecutive patients with VVS (age 31 ± 19 years, 33 male) who referred by a cardiologist or neurologist and had undergone an echocardiogram, HUT, and a treadmill exercise test (TMT) were recruited and clinically follow-up. Patients were divided into two groups based on the result of HUT and TMT. The data was analyzed and compared between VVS patients and control 141 patients without VVS who were enrolled in the same study period (age 40 ± 5 years, 117 male). Results: The heart rate recovery (HRR), recovery systolic blood pressure (RecSBP), recovery diastolic blood pressure (RecDBP), HRR/RecSBP and HRR/RecDBP were significantly different between controls and VVS during the TMT. Within VVS, even if, baseline characteristics were similar between negative and positive HUT (n = 92 vs. n = 51). HRR (31 ± 10 vs. 35 ± 10), HRR/RecSBP (0.24 ± 0.09 vs. 0.28 ± 0.09) and HRR/RecDBP (0.49 ± 0.18 vs. 0.58 ± 0.19) were significantly different between negative and positive HUT results. Especially, HRR/RecSBP and HRR/RecDBP were significantly correlated with induced syncope with a sensitivity and specificity ([60%, 83%] cut-off, 0.31; [72%, 80%] cut-off, 0.63). In the Cox regression, HRR/ RecDBP were significantly associated with recurrence of VVS with hazard ratio of 3.29 (confidence interval, 0.95 to 11.3; p = 0.049). Conclusions: HRR/RecDBP may be a useful predictor for induction during HUT and recurrence during follow-up in the VVS.
Abstract
Background/Aims: The induction and recurrence of syncope is a concerning situation that could be unpredicted in the vasovagal syncope (VVS). We investigated a simple predictor for the induced and recurrent VVS during Head-Up table-tilt Test (HUT) and clinically follow-up. Methods: The 143 consecutive patients with VVS (age 31 ± 19 years, 33 male) who referred by a cardiologist or neurologist and had undergone an echocardiogram, HUT, and a treadmill exercise test (TMT) were recruited and clinically follow-up. Patients were divided into two groups based on the result of HUT and TMT. The data was analyzed and compared between VVS patients and control 141 patients without VVS who were enrolled in the same study period (age 40 ± 5 years, 117 male). Results: The heart rate recovery (HRR), recovery systolic blood pressure (RecSBP), recovery diastolic blood pressure (RecDBP), HRR/RecSBP and HRR/RecDBP were significantly different between controls and VVS during the TMT. Within VVS, even if, baseline characteristics were similar between negative and positive HUT (n = 92 vs. n = 51). HRR (31 ± 10 vs. 35 ± 10), HRR/RecSBP (0.24 ± 0.09 vs. 0.28 ± 0.09) and HRR/RecDBP (0.49 ± 0.18 vs. 0.58 ± 0.19) were significantly different between negative and positive HUT results. Especially, HRR/RecSBP and HRR/RecDBP were significantly correlated with induced syncope with a sensitivity and specificity ([60%, 83%] cut-off, 0.31; [72%, 80%] cut-off, 0.63). In the Cox regression, HRR/ RecDBP were significantly associated with recurrence of VVS with hazard ratio of 3.29 (confidence interval, 0.95 to 11.3; p = 0.049). Conclusions: HRR/RecDBP may be a useful predictor for induction during HUT and recurrence during follow-up in the VVS.
참고문헌 (26)
- Baron-Esquivias G, "Long-term outcome of patients with vasovagal syncope", Am Heart J, 147, pp.883~889 (2004)
- Cintra F, "Heart rate variability during sleep in patients with vasovagal syncope", Pacing Clin Electrophysiol, 28, pp.1310~1316 (2005)
- Task Force for the Diagnosis and Management of Syncope, "Guidelines for the diagnosis and management of syncope (version 2009)", Eur Heart J, 30, pp.2631~2671 (2009)
- Sheldon RS, "2015 Heart Rhythm Society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope", Heart Rhythm, 12, pp.e41~ (2015)[DOI]
- D'Ascenzo F, "Incidence, etiology and predictors of adverse outcomes in 43, 315patients presenting to the Emergency Department with syncope : an international meta-analysis", Int J Cardiol, 167, pp.57~62 (2013)
- Guida P, "Prevalence, timing, and haemodynamic correlates of prodromes in patients with vasovagal syncope induced by head-up tilt test", Europace, 11, pp.1221~1226 (2009)
- Grubb BP, "Clinical practice. Neurocardiogenic syncope", N Engl J Med, 352, pp.1004~1010 (2005)
- Mereu R, "Heart rate", blood pressure ratio as predictor of neuromediated syncope, 2013, pp.167, 1170~1175
- Aydin MA, "Predicting recurrence of vasovagal syncope : a simple risk score for the clinical routine", J Cardiovasc Electrophysiol, 20, pp.416~421 (2009)
- Fletcher GF, "Exercise standards for testing and training : a scientific statement from the American Heart Association", Circulation, 128, pp.873~934 (2013)
- Jong Ho Shin, "Treadmill exercise-induced E", e’ elevation as a predictor of cardiovascular event in end-stage renal disease on peritoneal dialysis, 2016, ~[DOI]
- Mor-Avi V, "Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics : ASE", EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography, 2011, pp.24, 277~313
- Forleo C, "Head-up tilt testing for diagnosing vasovagal syncope : a meta-analysis", Int J Cardiol, 169, pp.e49~e50 (2013)
- Aerts AJ, "Reproducibility of nitrate-stimulated tilt testing in patients with suspected vasovagal syncope and a healthy control group", Am Heart J, 150, pp.251~256 (2005)
- Sheldon R, "Risk factors for syncope recurrence after a positive tilt-table test in patients with syncope", Circulation, 93, pp.973~981 (1996)
- Virag N, "Prediction of vasovagal syncope from heart rate and blood pressure trend and variability : experience in 1, 155patients", Heart Rhythm, 4, pp.1375~1382 (2007)
- Shinohara T, "Cardiac autonomic dysfunction in patients with head-up tilt test-induced vasovagal syncope", Pacing Clin Electrophysiol, 37, pp.1694~1701 (2014)
- Zygmunt A, "Heart rate variability in children with neurocardiogenic syncope", Clin Auton Res, 14, pp.99~106 (2004)
- Bechir M, "Dysfunctional baroreflex regulation of sympathetic nerve activity in patients with vasovagal syncope", Circulation, 107, pp.1620~1625 (2003)
- Cole CR, "Heart-rate recovery immediately after exercise as a predictor of mortality", N Engl J Med, 341, pp.1351~1357 (1999)
- Nishime EO, "Heart rate recovery and treadmill exercise score as predictors of mortality in patients referred for exercise ECG", JAMA, 284, pp.1392~1398 (2000)
- Morshedi-Meibodi A, "Heart rate recovery after treadmill exercise testing and risk of cardiovascular disease events(The Framingham Heart Study)", Am J Cardiol, 90, pp.848~852 (2002)
- Okutucu S, "Heart rate recovery : a practical clinical indicator of abnormal cardiac autonomic function", Expert Rev Cardiovasc Ther, 9, pp.1417~1430 (2011)
- Epstein SE, "Role of the capacitance and resistance vessels in vasovagal syncope", Circulation, 37, pp.524~533 (1968)
- Cooke WH, "Muscle sympathetic nerve activity during intense lower body negative pressure to presyncope in humans", J Physiol, 587(Pt 20), pp.4987~4999 (2009)
- Fu Q, "Pathophysiology of neurally mediated syncope : role of cardiac output and total peripheral resistance", Auton Neurosci, 184, pp.24~26 (2014)