Russo Vincenzo, Tariq Moiz, Parente Erika, Comune Angelo, Rago Anna, Papa Andrea Antonio, Nigro Gerardo, Brignole Michele
Cardiology and Syncope Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli"-Monaldi Hospital, Naples, Italy.
Cardiology and Syncope Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli"-Monaldi Hospital, Naples, Italy.
Eur J Intern Med. 2024 Dec;130:118-122. doi: 10.1016/j.ejim.2024.08.001. Epub 2024 Aug 7.
The aim of our study was to evaluate the prevalence and clinical predictors of vasodepressor (VD) response during head-up tilt test (HUTT) in patients with history of syncope admitted to a tertiary referral syncope unit.
We retrospectively evaluated all consecutive patients who underwent HUTT for suspected or established reflex syncope at our institution from March 1st, 2017, to June 1st, 2023. VD response was defined when syncope occurred during hypotension along with no or slight (< 10% bpm) decrease of heart rate. Univariate and multivariate analyses were performed to test the association of VD response to HUTT with a set of clinical covariates.
1780 patients (40 ± 19.9 years; 49.3% male) were included; among them, 1132 (63 %) showed a positive response to HUTT and 124 (7.0%) had a VD response. The prevalence of VD response showed a peak after 69 years (11.52% vs 6.18%; P = 0.0016), mainly driven by male patients (13.7% vs 4.9%; P < 0.0001). At multivariate analysis, age (OR: 1.15; P = 0.0026) was independently associated to HUTT-induced VD syncope; in contrast, smoking (OR: 0.33: P = 0.0009) and non-classical presentation of syncope (OR: 0.55; P = 0.0029) inversely correlated with VD syncope.
VD response represents the less frequent responses among those induced by HUTT, accounting up to 7% of overall responses. A gender and age-related distribution has been shown. Advanced age was the only independent predictor of VD syncope; conversely, smoking and non-classical presentation of syncope reduced the probability of VD response to HUTT.
我们研究的目的是评估入住三级转诊晕厥单元的晕厥病史患者在头高位倾斜试验（HUTT）期间血管减压（VD）反应的患病率及临床预测因素。
我们回顾性评估了2017年3月1日至2023年6月1日期间在我们机构因疑似或确诊反射性晕厥而接受HUTT的所有连续患者。VD反应定义为在低血压期间发生晕厥且心率无下降或轻微下降（<10次/分钟）。进行单因素和多因素分析以检验HUTT的VD反应与一组临床协变量之间的关联。
纳入1780例患者（40±19.9岁；49.3%为男性）；其中，1132例（63%）对HUTT呈阳性反应，124例（7.0%）有VD反应。VD反应的患病率在69岁后达到峰值（11.52%对6.18%；P = 0.0016），主要由男性患者驱动（13.7%对4.9%；P < 0.0001）。在多因素分析中，年龄（OR：1.15；P = 0.0026）与HUTT诱发的VD晕厥独立相关；相反，吸烟（OR：0.33：P = 0.0009）和非典型晕厥表现（OR：0.55；P = 0.0029）与VD晕厥呈负相关。
VD反应是HUTT诱发反应中较不常见的反应，占总反应的7%。已显示出与性别和年龄相关的分布。高龄是VD晕厥的唯一独立预测因素；相反，吸烟和非典型晕厥表现降低了对HUTT的VD反应概率。
