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20.06.2016 | Research Article

The pathophysiologic mechanisms associated with hypotensive susceptibility

verfasst von: Ashish Chaddha, Martina Rafanelli, Michele Brignole, Richard Sutton, Kevin E. Wenzke, Stephen L. Wasmund, Richard L. Page, Mohamed H. Hamdan

Erschienen in: Clinical Autonomic Research | Ausgabe 4/2016

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Abstract

Introduction

Patients with vasovagal syncope (VVS) and positive tilt table test (TTT) were not found to benefit from pacing in the ISSUE-3 trial despite the presence of spontaneous asystole during monitoring. “Hypotensive susceptibility” unmasked by TTT was reported as a possible explanation. The purpose of this study was to assess the pathophysiologic mechanisms associated with hypotensive susceptibility.

Methods

366 consecutive patients with the diagnosis of VVS who also had TTT were identified. Baroreflex gain (BRG) in addition to blood pressure (BP) and heart rate (HR) responses during the first 20 min of TTT were analyzed and compared between patients with positive TTT (n = 275, 75 %) and negative TTT (n = 91, 25 %).

Results

The mean BRG was similar between the groups (12.5 ± 6.3 versus 12.4 ± 6.3 ms/mmHg, p = 0.72); however, an age-dependent decrease was noted (17.6 ± 4.8, 15.0 ± 6.0, 10.6 ± 4.2, 10.3 ± 6.4 and 9.9 ± 8.5 ms/mmHg for patients <21, 21–40, 41–60, 61–80 and >80 years old, respectively; p < 0.001). In addition, we saw a main effect of age on the type of response with a greater prevalence of a vasodepressor response in older subjects (p < 0.001). During the first 20 min of TTT, BP was similar in patients with tilt-positive VVS when compared with patients with tilt-negative VVS; however, HR was significantly lower.

Conclusion

BRG is similar in tilt-positive VVS patients when compared with tilt-negative VVS patients. An age-dependent decrease in BRG was noted with a higher prevalence of a vasodepressor response seen in older patients. The clinical significance of the blunted HR response in tilt-positive VVS remains to be determined.

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Titel: The pathophysiologic mechanisms associated with hypotensive susceptibility
verfasst von: Ashish Chaddha
Martina Rafanelli
Michele Brignole
Richard Sutton
Kevin E. Wenzke
Stephen L. Wasmund
Richard L. Page
Mohamed H. Hamdan
Publikationsdatum: 20.06.2016
Verlag: Springer Berlin Heidelberg
Erschienen in: Clinical Autonomic Research / Ausgabe 4/2016
Print ISSN: 0959-9851
Elektronische ISSN: 1619-1560
DOI: https://doi.org/10.1007/s10286-016-0362-x

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The pathophysiologic mechanisms associated with hypotensive susceptibility