2006, Number 1
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Arch Cardiol Mex 2006; 76 (1)
Differential behavior of arterial tension in patients with neurocardiogenic syncope during the initial stage of the tilt table test
Asensio LE, Colín RE, Castillo ML, Oseguera MJ, Narváez DR, Dorantes GJ, Galindo UJ, Orea TA
Language: Spanish
References: 14
Page: 59-62
PDF size: 50.87 Kb.
ABSTRACT
Neurocardiogenic syncope (NCS) is diagnosed by means of a head-up tilt table tests (HUTT). This is a prolonged test although early outcome predictors are known.
Methods: We conducted a study among patients engaged in a syncope study protocol. We performed HUTT in all of them and compared the basal arterial pressure with the arterial pressure at the end of a the 70° tilting.
Results:
We performed 185 HUTT studies. Systolic blood pressure (BP) raised 0.9% among patients with a negative test, whereas patients with a positive HUTT showed a 2.3% decrease (p = 0.2) in the same measurement. Diastolic BP increased
34% among negative HUTT patients and 14.9% among patients with positive test (p = 0.02). We calculated a relative risk of 1.45 for positive test when the combination of systolic BD decrease and dyastolic increase was present, according to the percentage of change (IC95%: 1.1 to 7.8).
Conclusions: The combination of systolic BP reduction and diastolic BP elevation at the end of the 70° tilting is associated with an increased risk of having a positive HUTT. These changes might be related to differential sympathetic stimulation.
REFERENCES
MOSQUEDA GR, FURLAN R, TANK J, FERNÁNDEZ VR: The elusive pathophysiology of neurally mediated syncope. Circulation 2000; 102(23): 2898-906.
GRUBB B: Pathophysiology and differential diagnosis of neurocardiogenic syncope. Am J Cardiol 1999; 84(8A): p3Q-p9Q.
WHITE C, TSIKOURIS J: A review of pathophysiology and therapy of patients with vasovagal syncope. Pharmacotherapy 2000; 20(2): 158-65.
ARTHUR W, KAYE G: The pathophysiology of common causes of syncope. Postgrad Med J 2000; 76: 750-3.
GONZÁLEZ HERMOSILLO JA: Los síndromes de intolerancia ortostática. Arch Inst Cardiol Mex 2001; 71(Supl 1): 58-62.
GOLDSTEIN D, HOLMES C, FRANK S, NAQIBUDDIN M, DENDI R, SNADER S, CALKINS H: Sympathoadrenal imbalance before neurocardiogenic syncope. Am J Cardiol 2003; 91(1): 53-8.
OLGUNTURK R, TURAN L, TUNAOGLU F, KULA S, GOKCORA N, KARABACAK N, AZIZO G: Abnormality of the left ventricular sympathetic nervous function assessed by l123 metaiodobenzylguanidine imaging in pediatric patients with neurocardiogenic syncope. Pacing Clin Electrophysiol 2003; 26(10): 1926-30.
ALBONI P, BONDANELLI M, DINELLI M, GRUPILLO D, FRANCESCHETTI P, MARCHI P, DEGLI UBERTI E: Role of the serotoninergic system in the genesis of vasovagal syncope. Europace 2000; 2(2): 172-80.
GRUBB B, GERARD M, ROUSH K, TAMESY-ARMOS P, MONTFORD P, ELLIOTT L, ET AL: Cerebral vasoconstriction during Head-upright tilt-induced vasovagal syncope. A paradoxic and unexpected response. Circulation 1991; 84(3): 1157-64.
ASENSIO E, OSEGUERA J, LORÍA A, GÓMEZ M, NARVÁEZ R, DORANTES J, ET AL: Diagnostic findings and clinical correlations in patients studied because of syncope with a Head-up Tilt Table Test. Arch Med Research 2003; 34: 287-91.
MALLAT Z, VICAUT E, SANGARE A, VERSCHUEREN J, FONTAINE G, FRANK R: Prediction of head-up tilt test result by analysis of early heart rate variations. Circulation 1997; 96(2): 581-4.
ALVAREZ B, ASENSIO E, LOZANO E, PORTOS JM: Early heart rate variations during the Head-up tilt table testina as a predictor of the outcome the test. Pacing Clin Electrophysiol 2000; 23(1): 25-31.
GONZÁLEZ-HERMOSILLO A, JÁUREGUI K, KOSTINE A, MARQUEZ M, LARA J, CÁRDENAS M: Comparative study of cerebral blood flow between postural tachycardia and neurocardiogenic syncope during head-up tilt test. Europace 2002; 4(4): 369-74.
PITZALIS M, MASSARI F, GUIDA P, IACOVELLO M, MASTROPASQUA F, RISSON B, ET AL: Shortened head-up tilting test guided by systolic pressure reductions in neurocardiogenic syncope. Circulation 2002; 105: 146-8.