Babaei Mohammadreza, Tajdini Masih, Bozorgi Ali, Sadeghian Saeed, Taebi Morvarid, Tavolinejad Hamed, Mahalleh Mehrdad, Taheri Homa, Rader Florian, Boris Jeffrey R, Fedorowski Artur
Cardiovascular Diseases Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, North Kargar Street, Tehran 1411713138, Iran.
Division of Cardiology, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
Eur Heart J Open. 2025 Jun 11;5(3):oeaf061. doi: 10.1093/ehjopen/oeaf061. eCollection 2025 May.
Previous studies show inconsistencies in vasovagal syncope (VVS) symptoms and haemodynamic responses across age and sex groups, with limited evaluation of tilt test results. This study comprehensively examines differences in triggers, prodromal and syncopal symptoms, and head-up tilt test (HUTT) responses among VVS patients by age and sex providing new insights.
We analysed data from Syncope Unit of Tehran Heart Center, including adults (≥18 years) with suspected VVS diagnosis based on clinical history and physical exams according to syncope guidelines, to explore sex- and age-specific clinical features and HUTT outcomes. The study included 1914 VVS patients (mean age: 46.6 ± 17.8; 51.3% male). Males were more likely to experience first-time syncope (31.6% vs. 19.8%, < 0.001), whereas females had more recurrent episodes (37.5% vs. 31.2%, < 0.01) and reported more identifiable triggers. During the HUTT passive phase, females exhibited a greater diastolic blood pressure drop [49.5 ± 12.2 vs. 34.4 ± 17.2, = 0.012], while in the active phase, they experienced a more pronounced heart rate reduction 39.7 ± 26.9 vs. 30.2 ± 23.3, < 0.001. Cardioinhibitory syncope was more prevalent in younger patients, with over two-thirds of cases occurring in individuals under 50 years old, and its frequency declined with age. In contrast, vasodepressor syncope peaked in the 51-70 age group. Agreement between spontaneous and HUTT-induced syncope was low (κ = 0.06-0.32).
Age and sex shape VVS presentation, triggers, and haemodynamic response, emphasizing the need for demographic considerations in management and the limitations of HUTT.
先前的研究表明，血管迷走性晕厥（VVS）症状和血流动力学反应在不同年龄和性别组中存在不一致性，且对倾斜试验结果的评估有限。本研究全面考察了VVS患者中按年龄和性别划分的触发因素、前驱症状和晕厥症状以及头高位倾斜试验（HUTT）反应的差异，提供了新的见解。
我们分析了德黑兰心脏中心晕厥单元的数据，包括根据晕厥指南基于临床病史和体格检查疑似VVS诊断的成年人（≥18岁），以探讨性别和年龄特异性的临床特征及HUTT结果。该研究纳入了1914例VVS患者（平均年龄：46.6±17.8；51.3%为男性）。男性首次晕厥的可能性更高（31.6%对19.8%，<0.001），而女性复发发作更多（37.5%对31.2%，<0.01）且报告的可识别触发因素更多。在HUTT被动阶段，女性表现出更大的舒张压下降[49.5±12.2对34.4±17.2，P=0.012]，而在主动阶段，她们经历了更明显的心率降低[39.7±26.9对30.2±23.3，P<0.001]。心脏抑制性晕厥在年轻患者中更常见，超过三分之二的病例发生在50岁以下个体中，且其发生率随年龄下降。相比之下，血管减压性晕厥在51 - 70岁年龄组达到峰值。自发晕厥与HUTT诱发晕厥之间的一致性较低（κ=0.06 - 0.32）。
年龄和性别塑造了VVS的表现、触发因素和血流动力学反应，强调了在管理中考虑人口统计学因素的必要性以及HUTT的局限性。
