Is There A Structural Basis For Vasovagal Syncope? Cardiac Functions In Patients With Vasovagal Syncope

Year 2023, Volume: 6 Issue: 2, 267 - 271, 31.08.2023

Erkan Alpaslan , Ümmü Taş , Sedat Taş , Ebru Ozpelıt

https://doi.org/10.36516/jocass.1330346

Abstract

Aim: The pathophysiology of vasovagal syncope (VVS) is not completely understood. Some echocardiographic parameters have been defined to contribute to its pathophysiology. However. whether right atrial (RA) and right ventricular (RV) functions have any impact on development of VVS is not well known. In this study we aimed to evaluate the baseline echocardiographic parameters in patients with VVS with special focus on right ventricle and atrium functions.
Material and methods: We evaluated the medical records of 42 patients with VVS and 41 age and sex matched healthy subjects. Patients with at least two syncopal attack and positive head-up-tilt test were enrolled in the study. All medical records of echocardiography and head-up-tilt test were obtained.
Results: Among left ventricular function parameters, there were no significant difference between the groups. Right ventricle myocardial performance index (p= 0.003) and maximal pulmoner systolic flow velocity (PVmax) (p=0.03) were significantly differ between the groups. RAA was significantly larger (p=0.04) and the ratio of tricuspid filling velocities (E/A), (p=0.01) was significantly lower in VVS group.
Conclusions: The findings of the present study indicate a subtle right atrial diastolic dysfunction in patients with VVS. Decreased right atrial contribution to RV filling may cause a lower RV stroke volüme which explains the lower PVmax values in our VVS group. All together, those findings may serve for a tendency to low output states and hypotension as in VVS.

Keywords

vasovagal syncope, right ventricle, right atrium, PVmax

Vazovagal Senkopun Yapısal Bir Temeli Var mı? Vazovagal Senkoplu Hastalarda Kardiyak Fonksiyonlar

Abstract

Amaç: Vazovagal senkopun (VVS) patofizyolojisi tam olarak anlaşılamamıştır. Patofizyolojisine katkıda bulunmak için bazı ekokardiyografik parametreler tanımlanmıştır. Fakat. sağ atriyal (RA) ve sağ ventrikül (RV) fonksiyonlarının vazovagal senkop gelişimi üzerinde herhangi bir etkisinin olup olmadığı iyi bilinmemektedir. Bu çalışmada, özellikle sağ ventrikül ve atriyum fonksiyonlarına odaklanarak VVS’li hastalarda temel ekokardiyografik parametreleri değerlendirmeyi amaçladık.
Materyal ve metot: Vazovagal senkoplu 42 hasta ile yaş ve cinsiyet olarak eşleştirilmiş 41 sağlıklı kişinin tıbbi kayıtlarını inceledik. En az iki senkop atağı olan ve eğik masa testi pozitif olan hastalar çalışmaya alındı. Ekokardiyografi ve eğik masa testinin tüm tıbbi kayıtları elde edildi.
Bulgular: Sol ventrikül ölçümleri açısından gruplar arasında anlamlı fark yoktu. Sağ ventrikül miyokardiyal performans indeksi (p= 0.003) ve maksimal pulmoner sistolik akım hızı (PVmax) (p=0.03) gruplar arasında anlamlı farklılık gösterdi. Vazosvagal senkop grubunda RA alanı anlamlı olarak daha büyüktü (p=0.04) ve triküspit doluş hızları (Et/At), (p=0.01) oranı anlamlı olarak daha düşüktü.
Sonuç: Bu çalışmanın bulguları, VVS'li hastalarda hafif bir RV diyastolik işlev bozukluğuna işaret etmektedir. RV dolumuna sağ atriyal katkının azalması, daha düşük RV atım hacmine neden olabilir, bu da VVS grubumuzdaki daha düşük Pwmax değerlerini açıklayabilir. Hep birlikte değerlendirildiğinde, bu bulgular VVS'de olduğu gibi düşük kalp debisine ve hipotansiyona eğilime neden olabilir.

Keywords

Vazovagal senkop, sağ atrium, sağ ventrikül, PVmax

References

• 1.Zimmermann T, du Fay de Lavallaz J, Nestelberger T, et al. Incidence, char¬acteristics, determinants, and prognostic impact of recurrent syncope. EP Europace. 2020;22(12):1885-95.
• 2.Ganzeboom KS, Colman N, Reitsma JB, et al. Prevalence and triggers of syn¬cope in medical students. Am J Cardiol. 2003; 91(8): 1006-8. https://doi.org/10.1016/s0002-9149(03)00127-9
• 3.Serletis A, Rose S, Sheldon AG, et al. Vasovagal syncope in medical students and their first-degree relatives. Eur Heart J. 2006; 27(16): 1965-70. https://doi.org/10.1093/eurheartj/ehl147
• 4.Colman N, Nahm K, Ganzeboom K, et al. Epidemiology of reflex syncope. Clin Auton Res. 2004; 14: i9-i17. https://doi.org/10.1007/s10286-004-1003-3
• 5.Yılmaz ST, Binnetoğlu K, Babaoğlu K, et al. Predictors of vasovagal syncope recurrence in children and adolescents and value of head-up tilt table test. Anadolu Kardiyol Derg. 2013; 13(7): 688-94. https://doi.org/10.5152/akd.2013.194
• 6.Lindenberger M, Fedorowski A, Melander O, et al. Cardiovascular bi-omarkers and echocardiographic findings at rest and during graded hypovo¬lemic stress in women with recurrent vasovagal syncope. J Cardiovasc Elec¬trophysiol. 2019; 30(12): 2936-43. https://doi.org/10.1111/jce.14207
• 7.Tajdini M, Hosseinsabet A, Tofighi S, et al. Left atrial function evaluation by 2D speckle‐tracking echocardiography in patients with vasovagal syncope. Pacing and Clinical Electrophysiology. 2023; 46(4): 300-8.
• 8.Emren V, Kocabaş U, Levent F, et al. The Role of Right Ventricular Contrac¬tility in Patients Who Experienced Neurogenic Syncope. Koşuyolu Heart Journal. 2018; 21(2): 169-73. https://doi.org/10.5578/khj.66876
• 9.Virag N, Sutton R, Vetter R, et al. Prediction of vasovagal syncope from heart rate and blood pressure trend and variability: experience in 1,155 pa¬tients. Heart Rhythm. 2007; 4(11): 1375-82. https://doi.org/10.1016/j.hrthm.2007.07.018
• 10.Benditt DG, Ferguson DW, Grubb BP, et al. Tilt table testing for assessing syncope. J Am Coll Cardiol. 1996; 28(1): 263-75. https://doi.org/10.1016/0735-1097(96)00236-7
• 11.Teichholz LE, Kreulen T, Herman MV, et al. Problems in echocardio-graphic volume determinations: echocardiographic-angiographic correla-tions in the presence or absence of asynergy. J Am Coll Cardiol. 1976; 37(1):7-11. https://doi.org/10.1016/0002-9149(76)90491-4
• 12.Chuwa T, Rodeheffer RJ. New index of combined systolic and diastolic my¬ocardial performance: a simple and reproducible measure of cardiac func¬tion—a study in normals and dilated cardiomyopathy. J cardiol. 1995; 26(35): 7-366.
• 13.Bellard E, Fortrat J-O, Custaud M-A, et al. Increased hydration alone does not improve orthostatic tolerance in patients with neurocardiogenic syn¬cope. Clin Auton Res. 2007;17: 99-105. https://doi.org/10.1007/s10286-007-0409-0
• 14. Liao Y, Du J. Pathophysiology and individualized management of vasova¬gal syncope and postural tachycardia syndrome in children and adolescents: an update. Neuroscience Bulletin. 2020;36: 667-81.
• 15.Mosqueda-Garcia R, Furlan R, MD JT, et al. The elusive pathophysiology of neurally mediated syncope. Circ J. 2000; 102(23) :2898-906. https://doi.org/10.1161/01.cir.102.23.2898
• 16.Forleo C, Guida P, Iacoviello M, et al. Head-up tilt testing for diagnosing vasovagal syncope: A meta-analysis. Int J Cardiol 2013; 168: 27-35. https://doi.org/10.1016/j.ijcard.2012.09.023
• 17.Moon J, Kim H, Kim JY, et al. Left ventricular hypercontractility immedi-ately after tilting triggers a disregulated cardioinhibitory reaction in vasova¬gal syncope: echocardiographic evaluation during the head-up tilt test. Car¬diology. 2010; 117: 118-23. https://doi.org/10.1159/000320141
• 18.Goel R, Caracciolo G, Wilansky S, et al. Effect of head-up tilt-table testing on left ventricular longitudinal strain in patients with neurogenic syncope. Am J Cardiol 2013; 112: 1252-7. https://doi.org/10.1016/j.amjcard.2013.06.020
• 19.Sheldon R, Morillo C, Krahn A. Management of vasovagal syncope: 2004. Expert Rev Cardiovasc Ther. 2004; 2(6): 915–23. https://doi.org/10.1586/14779072.2.6.915
• 20.Gardenghi G, Rondon MU, Braga AM, et al. The effects of exercise training on arterial baroreflex sensitivity in neurally mediated syncope patients. Eur Heart J. 2007; 28 (22): 2749–55. https://doi.org/10.1093/eurheartj/ehm208
• 21.Krediet CT, de Bruin IG, Ganzeboom KS, et al. Leg crossing, muscle tens-ing, squatting, and the crash position are effective against vasovagal reac-tions solely through increases in cardiac output. J Appl Physiol. 2005; 99(5):1697–1703. https://doi.org/10.1152/japplphysiol.01250.2004
• 22.Rickson JJ, Maris SA, Headley SA. Isometric exercise training: A review of hypothesized mechanisms and protocol application in persons with hyper¬tension. International Journal of Exercise Science. 2021; 14(2): 1261.
• 23.Baffour-Awuah B, Pearson MJ, Dieberg G, et al. An evidence-based guide to the efficacy and safety of isometric resistance training in hypertension and clinical implications. Clinical Hypertension. 2023; 29(1): 9.
• 24.Sotiriadou M, Papadopoulos CE, Antoniadis AP, et al. The impact of atrial mechanical function on age‐dependent presentation of neurocardiogenic syncope. Clin Cardiol. 2021; 44(10): 1440-7. https://doi.org/10.1002/clc.23704
• 25.Raj SR, Coffin ST. Medical therapy and physical maneuvers in the treat-ment of the vasovagal syncope and orthostatic hypotension. Prog Cardiovasc Dis. 2013; 55(4): 425-33. https://doi.org/10.1016/j.pcad.2012.11.004