Division of Cardiology, Eulji University Hospital, Daejeon, Korea.
Division of Neurology, Eulji University Hospital, Daejeon, Korea.
Korean J Intern Med. 2019 Mar;34(2):315-323. doi: 10.3904/kjim.2017.180. Epub 2017 Dec 18.
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.
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).
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).
HRR/RecDBP may be a useful predictor for induction during HUT and recurrence during follow-up in the VVS.
背景/目的：血管迷走性晕厥（VVS）中，晕厥的诱发和复发是一种令人担忧的情况，可能无法预测。我们研究了在头高位倾斜试验（HUT）期间和临床随访中用于预测诱发性和复发性 VVS 的简单指标。
连续招募了 143 名由心脏病专家或神经科医生转诊、接受过超声心动图、HUT 和跑步机运动试验（TMT）的 VVS 患者（年龄 31 ± 19 岁，33 名男性），并进行了临床随访。根据 HUT 和 TMT 的结果，患者被分为两组。分析并比较了 VVS 患者与同一研究期间纳入的 141 名无 VVS 的对照组患者（年龄 40 ± 5 岁，117 名男性）的数据。
在 TMT 期间，对照组和 VVS 患者之间的心率恢复（HRR）、恢复收缩压（RecSBP）、恢复舒张压（RecDBP）、HRR/RecSBP 和 HRR/RecDBP 差异有统计学意义。即使在 HUT 阴性和阳性的 VVS 患者中，基线特征也相似（n = 92 与 n = 51）。HRR（31 ± 10 与 35 ± 10）、HRR/RecSBP（0.24 ± 0.09 与 0.28 ± 0.09）和 HRR/RecDBP（0.49 ± 0.18 与 0.58 ± 0.19）差异有统计学意义。尤其是 HRR/RecSBP 和 HRR/RecDBP 与诱发性晕厥显著相关，其敏感性和特异性（[60%，83%]截断值，0.31；[72%，80%]截断值，0.63）。在 Cox 回归中，HRR/RecDBP 与 VVS 的复发显著相关，风险比为 3.29（置信区间为 0.95 至 11.3；p = 0.049）。
HRR/RecDBP 可能是 HUT 期间诱导和随访期间 VVS 复发的有用预测指标。
