Wu Tan Chen, Hachul Denise T, Darrieux Francisco Carlos da Costa, Scanavacca Maurício I
Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil.
Arq Bras Cardiol. 2018 Jul;111(1):84-91. doi: 10.5935/abc.20180114.
Carotid sinus hypersensitivity (CSH) is a frequent finding in the evaluation of syncope. However, its significance in the clinical setting is still dubious. A new criterion was proposed by Solari et al. with a symptomatic systolic blood pressure (SBP) cut-off value of ≤ 85 mmHg to refine the vasodepressor (VD) response diagnosis.
To determine and compare the response to carotid sinus massage (CSM) in patients with and without syncope according to standard and proposed criteria.
CSM was performed in 99 patients with and 66 patients without syncope. CSH was defined as cardioinhibitory (CI) for asystole ≥ 3 seconds, or as VD for SBP decrease ≥ 50 mmHg.
No differences in the hemodynamic responses were observed during CSM between the groups, with 24.2% and 25.8% CI, and 8.1% and 13.6% VD in the symptomatic and asymptomatic groups, respectively (p = 0.466). A p value < 0.050 was considered statistically significant. During the maneuvers, 45 (45.45%) and 34 (51.5%) patients in the symptomatic and asymptomatic groups achieved SBP below ≤ 85 mmHg. Symptoms were reported especially in those patients in whom CSM caused a SBP decrease to below 90 mmHg and/or asystole > 2.5 seconds, regardless of the pattern of response or the presence of previous syncope.
The response to CSM in patients with and without syncope was similar; therefore, CSH may be an unspecific condition. Clinical correlation and other methods of evaluation, such as long-lasting ECG monitoring, may be necessary to confirm CSH as the cause of syncope.
在晕厥评估中，颈动脉窦过敏（CSH）是常见发现。然而，其在临床环境中的意义仍不明确。索拉里等人提出了一项新标准，将有症状时收缩压（SBP）截止值设定为≤85 mmHg，以完善血管减压（VD）反应诊断。
根据标准和提议标准，确定并比较有晕厥和无晕厥患者对颈动脉窦按摩（CSM）的反应。
对99例有晕厥患者和66例无晕厥患者进行CSM。CSH被定义为心脏抑制（CI）性停搏≥3秒，或VD性SBP下降≥50 mmHg。
两组在CSM期间的血流动力学反应未观察到差异，有症状组和无症状组的CI分别为24.2%和25.8%，VD分别为8.1%和13.6%（p = 0.466）。p值<0.050被认为具有统计学意义。在操作过程中，有症状组和无症状组分别有45例（45.45%）和34例（51.5%）患者的SBP降至≤85 mmHg以下。尤其是那些CSM导致SBP降至90 mmHg以下和/或停搏>2.5秒的患者报告了症状，无论反应模式或既往晕厥情况如何。
有晕厥和无晕厥患者对CSM的反应相似；因此，CSH可能是一种非特异性情况。可能需要临床相关性和其他评估方法，如长时间心电图监测，以确认CSH是晕厥的原因。
