Díaz José Francisco, Tercedor Luis, Moreno Eduardo, García Rocío, Alvarez Miguel, Sánchez Jesús, Azpitarte José
Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain.
Rev Esp Cardiol. 2002 May;55(5):487-92. doi: 10.1016/s0300-8932(02)76640-2.
Little information is available on the evolution of pediatric patients with vasovagal syncope. We therefore aimed to assess the medium-term clinical outcome of children evaluated by tilt testing for syncope of unknown origin.
Fifty-one children under 17 years of age who had undergone tilt testing were identified from a data base and studied prospectively. Kaplan-Meier and Cox regression analyses were performed to estimate syncope-free survival, its predictors, and the relative risks of several patient subgroups.
Forty-seven (92%) of the children were followed for a mean 21 9 months. The rate of recurrence of syncope was considerably lower than that estimated during history taking before the tilt test (19% vs 47%; p < 0.01). Although the low rate made it difficult to identify predictors, several potential predictors emerged from the multivariate analysis. Only the history of more than one syncope before the tilt test (vs. isolated syncope) was found to have independent predictive value (p = 0.04). The cumulative probability of recurrence projected for a period of 38 months was 66.2% (SEM = 16.5%) for children with more than one syncope before testing vs. 0% for those who had experienced only one. No other events occurred.
The medium-term prognosis seems to be good for children with vasovagal syncope of unknown origin, given the low rate of recurrence, regardless of the results of tilt testing. The only predictor of recurrent syncope was pretest history, such that children with only one syncope before testing experience no recurrence and those with one or more episodes are estimated to have an increasingly higher likelihood of recurrence. These data may be useful for the recommending tilt testing and for planning therapy for children with vasovagal syncope.
关于小儿血管迷走性晕厥演变的信息较少。因此，我们旨在评估通过倾斜试验评估不明原因晕厥儿童的中期临床结局。
从数据库中识别出51名17岁以下接受过倾斜试验的儿童，并进行前瞻性研究。采用Kaplan-Meier和Cox回归分析来估计无晕厥生存率、其预测因素以及几个患者亚组的相对风险。
47名（92%）儿童平均随访21.9个月。晕厥复发率明显低于倾斜试验前病史采集时估计的复发率（19%对47%；p<0.01）。尽管低复发率使得难以识别预测因素，但多变量分析中出现了几个潜在的预测因素。仅发现倾斜试验前有不止一次晕厥病史（与孤立性晕厥相比）具有独立预测价值（p=0.04）。试验前有不止一次晕厥的儿童在38个月期间的复发累积概率为66.2%（标准误=16.5%），而仅有一次晕厥的儿童复发累积概率为0%。未发生其他事件。
对于不明原因的小儿血管迷走性晕厥患者，鉴于复发率较低，中期预后似乎良好，无论倾斜试验结果如何。复发晕厥的唯一预测因素是试验前病史，即试验前仅有一次晕厥的儿童无复发，而有一次或多次发作的儿童复发可能性越来越高。这些数据可能有助于推荐倾斜试验以及为小儿血管迷走性晕厥患者制定治疗方案。
