Association between hypotension during 24 h ambulatory blood pressure monitoring and reflex syncope : the SynABPM 1 study
Rivasi, Giulia ; Groppelli, Antonella ; Brignole, Michele ; Soranna, Davide ; Zambon, Antonella ; Bilo, Grzegorz ; Pengo, Martino ; Sharad, Bashaaer ; Hamrefors, Viktor LU
and Rafanelli, Martina
, et al.
(2022)
In European Heart Journal
43(38).
p.3765-3776
- Abstract
AIMS: Diagnostic criteria for ambulatory blood pressure monitoring (ABPM) in patients with suspected reflex syncope are lacking. The study hypothesis was that patients with reflex syncope have a higher prevalence of systolic blood pressure (SBP) drops on ABPM.
METHODS AND RESULTS: ABPM data from reflex syncope patients and controls, matched by average 24 h SBP, age, sex, and hypertension were compared. Patients with constitutional hypotension, orthostatic hypotension, and predominant cardioinhibition during carotid sinus massage or prolonged electrocardiogram monitoring or competing causes of syncope were excluded. Daytime and nighttime SBP drops (<110, 100, 90, 80 mmHg) were assessed. Findings were validated in an independent... (More)
AIMS: Diagnostic criteria for ambulatory blood pressure monitoring (ABPM) in patients with suspected reflex syncope are lacking. The study hypothesis was that patients with reflex syncope have a higher prevalence of systolic blood pressure (SBP) drops on ABPM.
METHODS AND RESULTS: ABPM data from reflex syncope patients and controls, matched by average 24 h SBP, age, sex, and hypertension were compared. Patients with constitutional hypotension, orthostatic hypotension, and predominant cardioinhibition during carotid sinus massage or prolonged electrocardiogram monitoring or competing causes of syncope were excluded. Daytime and nighttime SBP drops (<110, 100, 90, 80 mmHg) were assessed. Findings were validated in an independent sample. In the derivation sample, daytime SBP drops were significantly more common in 158 syncope patients than 329 controls. One or more daytime drops <90 mmHg achieved 91% specificity and 32% sensitivity [odds ratio (OR) 4.6, P < 0.001]. Two or more daytime drops <100 mmHg achieved 84% specificity and 40% sensitivity (OR 3.5, P = 0.001). Results were confirmed in the validation sample of 164 syncope patients and 164 controls: one or more daytime SBP drops <90 mmHg achieved 94% specificity and 29% sensitivity (OR 6.2, P < 0.001), while two or more daytime SBP drops <100 mmHg achieved 83% specificity and 35% sensitivity (OR 2.6, P < 0.001).
CONCLUSION: SBP drops during ABPM are more common in reflex syncope patients than in controls. Cut-off values that may be applied in clinical practice are defined. This study expands the current indications for ABPM to patients with reflex syncope.
(Less)
- author
- Rivasi, Giulia
; Groppelli, Antonella
; Brignole, Michele
; Soranna, Davide
; Zambon, Antonella
; Bilo, Grzegorz
; Pengo, Martino
; Sharad, Bashaaer
; Hamrefors, Viktor
LU
and Rafanelli, Martina
, et al. (More)
- Rivasi, Giulia
; Groppelli, Antonella
; Brignole, Michele
; Soranna, Davide
; Zambon, Antonella
; Bilo, Grzegorz
; Pengo, Martino
; Sharad, Bashaaer
; Hamrefors, Viktor
LU
; Rafanelli, Martina
; Testa, Giuseppe Dario
; Rice, Ciara
; Kenny, Rose Anne
; Sutton, Richard
LU
; Ungar, Andrea
; Fedorowski, Artur
LU
and Parati, Gianfranco
(Less)
- organization
- publishing date
- 2022-06-29
- type
- Contribution to journal
- publication status
- published
- subject
- in
- European Heart Journal
- volume
- 43
- issue
- 38
- pages
- 3765 - 3776
- publisher
- Oxford University Press
- external identifiers
-
- pmid:35766175
- scopus:85139739383
- ISSN
- 1522-9645
- DOI
- 10.1093/eurheartj/ehac347
- language
- English
- LU publication?
- yes
- additional info
- © The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Cardiology.
- id
- b2b1161c-1aa4-458e-a221-d9eef7b7404f
- date added to LUP
- 2022-07-01 17:24:23
- date last changed
- 2024-06-27 16:46:56
@article{b2b1161c-1aa4-458e-a221-d9eef7b7404f,
abstract = {{<p>AIMS: Diagnostic criteria for ambulatory blood pressure monitoring (ABPM) in patients with suspected reflex syncope are lacking. The study hypothesis was that patients with reflex syncope have a higher prevalence of systolic blood pressure (SBP) drops on ABPM.</p><p>METHODS AND RESULTS: ABPM data from reflex syncope patients and controls, matched by average 24 h SBP, age, sex, and hypertension were compared. Patients with constitutional hypotension, orthostatic hypotension, and predominant cardioinhibition during carotid sinus massage or prolonged electrocardiogram monitoring or competing causes of syncope were excluded. Daytime and nighttime SBP drops (<110, 100, 90, 80 mmHg) were assessed. Findings were validated in an independent sample. In the derivation sample, daytime SBP drops were significantly more common in 158 syncope patients than 329 controls. One or more daytime drops <90 mmHg achieved 91% specificity and 32% sensitivity [odds ratio (OR) 4.6, P < 0.001]. Two or more daytime drops <100 mmHg achieved 84% specificity and 40% sensitivity (OR 3.5, P = 0.001). Results were confirmed in the validation sample of 164 syncope patients and 164 controls: one or more daytime SBP drops <90 mmHg achieved 94% specificity and 29% sensitivity (OR 6.2, P < 0.001), while two or more daytime SBP drops <100 mmHg achieved 83% specificity and 35% sensitivity (OR 2.6, P < 0.001).</p><p>CONCLUSION: SBP drops during ABPM are more common in reflex syncope patients than in controls. Cut-off values that may be applied in clinical practice are defined. This study expands the current indications for ABPM to patients with reflex syncope.</p>}},
author = {{Rivasi, Giulia and Groppelli, Antonella and Brignole, Michele and Soranna, Davide and Zambon, Antonella and Bilo, Grzegorz and Pengo, Martino and Sharad, Bashaaer and Hamrefors, Viktor and Rafanelli, Martina and Testa, Giuseppe Dario and Rice, Ciara and Kenny, Rose Anne and Sutton, Richard and Ungar, Andrea and Fedorowski, Artur and Parati, Gianfranco}},
issn = {{1522-9645}},
language = {{eng}},
month = {{06}},
number = {{38}},
pages = {{3765--3776}},
publisher = {{Oxford University Press}},
series = {{European Heart Journal}},
title = {{Association between hypotension during 24 h ambulatory blood pressure monitoring and reflex syncope : the SynABPM 1 study}},
url = {{http://dx.doi.org/10.1093/eurheartj/ehac347}},
doi = {{10.1093/eurheartj/ehac347}},
volume = {{43}},
year = {{2022}},
}