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Mechanism of syncope : role of ambulatory blood pressure monitoring and cardiovascular autonomic function assessment

Groppelli, Antonella ; Russo, Vincenzo ; Parente, Erika ; Comune, Angelo ; de Lange, Frederik J ; Rivasi, Giulia ; Rafanelli, Martina ; Deharo, Jean Claude ; Francisco-Pascual, Jaume and Maggi, Roberto , et al. (2024) In European Heart Journal p.1-9
Abstract

BACKGROUND AND AIMS: Identifying the haemodynamic mechanism of autonomic syncope is the essential pre-requisite for effective and personalized therapy aimed at preventing recurrences. The present study assessed the diagnostic efficacy of a two-step assessment.

METHODS: Multicentre prospective, cross-sectional, observational study. Patients affected by severe autonomic syncope underwent a two-step assessment including 24-h ambulatory blood pressure monitoring and short cardiovascular autonomic function assessment (SCAFA). SCAFA consisted of carotid sinus massage (CSM), performed in patients ≥40 years old, a passive standing test, and a 'fast' head-up tilt test scheduled sequentially during one session on a tilt... (More)

BACKGROUND AND AIMS: Identifying the haemodynamic mechanism of autonomic syncope is the essential pre-requisite for effective and personalized therapy aimed at preventing recurrences. The present study assessed the diagnostic efficacy of a two-step assessment.

METHODS: Multicentre prospective, cross-sectional, observational study. Patients affected by severe autonomic syncope underwent a two-step assessment including 24-h ambulatory blood pressure monitoring and short cardiovascular autonomic function assessment (SCAFA). SCAFA consisted of carotid sinus massage (CSM), performed in patients ≥40 years old, a passive standing test, and a 'fast' head-up tilt test scheduled sequentially during one session on a tilt table.

RESULTS: The study population consisted of 333 patients, 102 ≤ 40 years old and 231 > 40 years old. Any positive response was observed in 298 (89%) patients (92 [92%] in younger and 134 [89%] in older), with hypotensive phenotype accounting for 226 (68%), bradycardic phenotype for 21 (6%) and mixed phenotype for 51 (15%) of cases. The mean duration of the SCAFA procedure was 25 (IQR 20-32) min. Ambulatory blood pressure monitoring, CSM, passive standing, and head-up tilt test were positive in 60%, 15%, 3%, and 71% of patients, respectively. More than one test was positive in 51% and 49% of patients ≤40 and >40 years, respectively. Large inter-centre variability of CSM positivity rate, which remained significant after adjustment for demographic and clinical variables, was observed (P = .003).

CONCLUSIONS: The standardized 2STEPS protocol offers an easy-to-perform and time-saving diagnostic work-up allowing identification of the haemodynamic mechanism of loss of consciousness in most patients with autonomic syncope. This protocol provides the necessary background for a personalized mechanism-specific therapy.

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publishing date
type
Contribution to journal
publication status
epub
in
European Heart Journal
article number
ehae907
pages
1 - 9
publisher
Oxford University Press
external identifiers
  • scopus:86000160060
  • pmid:39786439
ISSN
1522-9645
DOI
10.1093/eurheartj/ehae907
language
English
LU publication?
no
additional info
© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.
id
6286b3b1-4744-4e0a-8901-184a159d9cfa
date added to LUP
2025-01-13 15:22:50
date last changed
2025-08-01 22:49:38
@article{6286b3b1-4744-4e0a-8901-184a159d9cfa,
  abstract     = {{<p>BACKGROUND AND AIMS: Identifying the haemodynamic mechanism of autonomic syncope is the essential pre-requisite for effective and personalized therapy aimed at preventing recurrences. The present study assessed the diagnostic efficacy of a two-step assessment.</p><p>METHODS: Multicentre prospective, cross-sectional, observational study. Patients affected by severe autonomic syncope underwent a two-step assessment including 24-h ambulatory blood pressure monitoring and short cardiovascular autonomic function assessment (SCAFA). SCAFA consisted of carotid sinus massage (CSM), performed in patients ≥40 years old, a passive standing test, and a 'fast' head-up tilt test scheduled sequentially during one session on a tilt table.</p><p>RESULTS: The study population consisted of 333 patients, 102 ≤ 40 years old and 231 &gt; 40 years old. Any positive response was observed in 298 (89%) patients (92 [92%] in younger and 134 [89%] in older), with hypotensive phenotype accounting for 226 (68%), bradycardic phenotype for 21 (6%) and mixed phenotype for 51 (15%) of cases. The mean duration of the SCAFA procedure was 25 (IQR 20-32) min. Ambulatory blood pressure monitoring, CSM, passive standing, and head-up tilt test were positive in 60%, 15%, 3%, and 71% of patients, respectively. More than one test was positive in 51% and 49% of patients ≤40 and &gt;40 years, respectively. Large inter-centre variability of CSM positivity rate, which remained significant after adjustment for demographic and clinical variables, was observed (P = .003).</p><p>CONCLUSIONS: The standardized 2STEPS protocol offers an easy-to-perform and time-saving diagnostic work-up allowing identification of the haemodynamic mechanism of loss of consciousness in most patients with autonomic syncope. This protocol provides the necessary background for a personalized mechanism-specific therapy.</p>}},
  author       = {{Groppelli, Antonella and Russo, Vincenzo and Parente, Erika and Comune, Angelo and de Lange, Frederik J and Rivasi, Giulia and Rafanelli, Martina and Deharo, Jean Claude and Francisco-Pascual, Jaume and Maggi, Roberto and Fedorowski, Artur and Ungar, Andrea and Parati, Gianfranco and Brignole, Michele}},
  issn         = {{1522-9645}},
  language     = {{eng}},
  month        = {{12}},
  pages        = {{1--9}},
  publisher    = {{Oxford University Press}},
  series       = {{European Heart Journal}},
  title        = {{Mechanism of syncope : role of ambulatory blood pressure monitoring and cardiovascular autonomic function assessment}},
  url          = {{http://dx.doi.org/10.1093/eurheartj/ehae907}},
  doi          = {{10.1093/eurheartj/ehae907}},
  year         = {{2024}},
}