Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
BMC Cardiovasc Disord. 2022 Oct 28;22(1):451. doi: 10.1186/s12872-022-02901-5.
Head-up tilt test (HUTT) is clinically advantageous for diagnosing patients with vasovagal syncope (VVS). Nitroglycerin is mainly used as a stimulant during HUTT, and mitochondrial aldehyde dehydrogenase 2 (ALDH2) is involved in the metabolism of nitroglycerin (NTG). ALDH2 Glu487Lys polymorphism (ALDH2 rs671) is the most common variant in the East Asian population. This study aimed to assess the effects of ALDH2 rs671 on VVS patients undergoing HUTT supplemented with sublingual NTG (HUTT-NTG). METHODS: Patients with recurrent VVS (at least 2 times) who were admitted to the syncope center of our hospital were enrolled. All VVS patients have undergone HUTT. The polymorphism of Glu487Lys gene of ALDH2 was measured by the DNA Microarray Chip Method. The results of HUTT-NTG of VVS patients with different ALDH2 genotypes were compared and their hemodynamic characteristics were assessed.
A total of 199 VVS patients were enrolled, including 101 patients in the ALDH21/1 group and 98 patients in the ALDH22 group. Among patients undergoing HUTT-NTG, 70.3% of patients in the ALDH21/1 group and 68.4% of patients in the ALDH22 group were positive, and the difference between the two groups was not statistically significant (P = 0.77). The proportions of VASIS I, VASIS II, and VASIS III were 40.6%, 8.9%, and 20.8% in the ALDH21/1 group, respectively, and the corresponding proportions in the ALDH22 group were 36.7%, 11.2%, and 20.4%, respectively. There was no statistically significant difference between the two groups (P = 0.91). The hemodynamic characteristics of different genotypes in VVS patients undergoing HUTT-NTG were compared, and no statistically significant difference was found. The median time of syncopal episode occurred after NTG administration in the ALDH21/1 group was 6 min (interquartile range [IQR]: 5.0-9.0), and it was 6.0 min in the ALDH22 group (IQR: 4.25-8.0, P = 0.64).
ALDH2 Glu487Lys polymorphism did not affect the outcome of VVS patients undergoing HUTT-NTG, and no significant change in the hemodynamic characteristics of different genotypes was found.
直立倾斜试验（HUTT）在诊断血管迷走性晕厥（VVS）患者方面具有临床优势。硝酸甘油主要用作 HUTT 中的兴奋剂，而线粒体醛脱氢酶 2（ALDH2）参与硝酸甘油（NTG）的代谢。ALDH2Glu487Lys 多态性（ALDH2 rs671）是东亚人群中最常见的变体。本研究旨在评估 ALDH2 rs671 对接受舌下硝酸甘油（HUTT-NTG）补充的 VVS 患者的影响。
本研究纳入了因反复发作 VVS（至少 2 次）而入住我院晕厥中心的患者。所有 VVS 患者均接受了 HUTT。通过 DNA 微阵列芯片法测量 ALDH2 中 Glu487Lys 基因的多态性。比较了不同 ALDH2 基因型 VVS 患者 HUTT-NTG 的结果，并评估了其血液动力学特征。
共纳入 199 例 VVS 患者，其中 ALDH21/1 组 101 例，ALDH22 组 98 例。在接受 HUTT-NTG 的患者中，ALDH21/1 组有 70.3%的患者为阳性，ALDH22 组有 68.4%的患者为阳性，两组间差异无统计学意义（P=0.77）。ALDH21/1 组的 VASIS I、VASIS II 和 VASIS III 的比例分别为 40.6%、8.9%和 20.8%，ALDH22 组的相应比例分别为 36.7%、11.2%和 20.4%，两组间差异无统计学意义（P=0.91）。比较不同基因型 VVS 患者接受 HUTT-NTG 后的血液动力学特征，未发现统计学差异。ALDH21/1 组 NTG 给药后晕厥发作的中位时间为 6 分钟（四分位间距 [IQR]：5.0-9.0），ALDH22 组为 6.0 分钟（IQR：4.25-8.0，P=0.64）。
ALDH2Glu487Lys 多态性不影响接受 HUTT-NTG 的 VVS 患者的结局，不同基因型的血液动力学特征也无明显变化。
