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Age and sex differences in vasovagal syncope : triggers, clinical presentation, prodromal symptoms, and head-up tilt test results

Babaei, Mohammadreza ; Tajdini, Masih ; Bozorgi, Ali ; Sadeghian, Saeed ; Taebi, Morvarid ; Tavolinejad, Hamed ; Mahalleh, Mehrdad ; Taheri, Homa ; Florian, Rader and Boris, Jeffrey R , et al. (2025) In European Heart Journal Open 5(3).
Abstract

AIMS: 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.

METHODS AND RESULTS: 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... (More)

AIMS: 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.

METHODS AND RESULTS: 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%,
P < 0.001), whereas females had more recurrent episodes (37.5% vs. 31.2%,
P < 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,
P = 0.012], while in the active phase, they experienced a more pronounced heart rate reduction 39.7 ± 26.9 vs. 30.2 ± 23.3,
P < 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).

CONCLUSION: Age and sex shape VVS presentation, triggers, and haemodynamic response, emphasizing the need for demographic considerations in management and the limitations of HUTT.

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publishing date
type
Contribution to journal
publication status
published
subject
in
European Heart Journal Open
volume
5
issue
3
article number
oeaf061
publisher
Oxford University Press
external identifiers
  • pmid:40503339
  • scopus:105008372467
ISSN
2752-4191
DOI
10.1093/ehjopen/oeaf061
language
English
LU publication?
no
additional info
© The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology.
id
be66e5b1-6cde-4f2f-a49b-c76167d86144
date added to LUP
2025-06-16 15:52:28
date last changed
2025-07-15 04:41:26
@article{be66e5b1-6cde-4f2f-a49b-c76167d86144,
  abstract     = {{<p>AIMS: 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.</p><p>METHODS AND RESULTS: 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%,<br>
 P &lt; 0.001), whereas females had more recurrent episodes (37.5% vs. 31.2%,<br>
 P &lt; 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,<br>
 P = 0.012], while in the active phase, they experienced a more pronounced heart rate reduction 39.7 ± 26.9 vs. 30.2 ± 23.3,<br>
 P &lt; 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).<br>
 </p><p>CONCLUSION: Age and sex shape VVS presentation, triggers, and haemodynamic response, emphasizing the need for demographic considerations in management and the limitations of HUTT.</p>}},
  author       = {{Babaei, Mohammadreza and Tajdini, Masih and Bozorgi, Ali and Sadeghian, Saeed and Taebi, Morvarid and Tavolinejad, Hamed and Mahalleh, Mehrdad and Taheri, Homa and Florian, Rader and Boris, Jeffrey R and Fedorowski, Artur}},
  issn         = {{2752-4191}},
  language     = {{eng}},
  number       = {{3}},
  publisher    = {{Oxford University Press}},
  series       = {{European Heart Journal Open}},
  title        = {{Age and sex differences in vasovagal syncope : triggers, clinical presentation, prodromal symptoms, and head-up tilt test results}},
  url          = {{http://dx.doi.org/10.1093/ehjopen/oeaf061}},
  doi          = {{10.1093/ehjopen/oeaf061}},
  volume       = {{5}},
  year         = {{2025}},
}