TY - JOUR
T1 - Impact of Cardiovascular Neurohormones on Onset of Vasovagal Syncope Induced by Head-up Tilt
AU - Torabi, Parisa
AU - Ricci, Fabrizio
AU - Hamrefors, Viktor
AU - Melander, Olle
AU - Sutton, Richard
AU - Benditt, David G.
AU - Fedorowski, Artur
N1 - Publisher Copyright:
© 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2019
Y1 - 2019
N2 - Background: Vasovagal reflex is the most common form of syncope, but the pathophysiological mechanisms that initiate the reflex are not well understood. We aimed to study supine and early orthostatic levels of the neurohormones involved in control of circulatory homeostasis in relation to the onset of tilt-induced vasovagal syncope (VVS). Methods and Results: A total of 827 patients who were investigated for unexplained syncope with head-up tilt test (HUT) and optional nitroglycerin provocation (Italian protocol) had blood samples collected while supine and after 3-minutes of HUT. Of these, 173 (20.9%) patients developed VVS during drug-free HUT, 161 of whom (males 44.7%; age 45±21 years) had complete data. We analyzed levels of epinephrine, norepinephrine, C-terminal pro–arginine vasopressin, C-terminal endothelin-1, and midregional fragments of pro–atrial natriuretic peptide and pro-adrenomedullin in relation to time from tilt-up to onset of VVS. We applied a linear regression model adjusted for age and sex. The mean time to syncope was 11±7 minutes. Older age (β=0.13; SE=0.03, P<0.001), higher supine systolic blood pressure (β=0.06; SE=0.03, P=0.02), and higher supine midregional fragment of pro-adrenomedullin predicted longer time to syncope (β=2.31; SE=0.77, P=0.003), whereas supine levels of other neurohormones were not associated with time to syncope. Among 151 patients who developed VVS later than 3 minutes of HUT, increase in epinephrine (β=−3.24; SE=0.78, P<0.001) and C-terminal pro–arginine vasopressin (β=−2.07; SE=0.61, P=0.001) at 3 minutes of HUT were related to shorter time to syncope. Conclusions: Older age, higher blood pressure, and higher level of pro-adrenomedullin are associated with later onset of VVS during tilt testing, whereas greater increase of tilt-induced epinephrine and vasopressin release correlate with shorter time to syncope.
AB - Background: Vasovagal reflex is the most common form of syncope, but the pathophysiological mechanisms that initiate the reflex are not well understood. We aimed to study supine and early orthostatic levels of the neurohormones involved in control of circulatory homeostasis in relation to the onset of tilt-induced vasovagal syncope (VVS). Methods and Results: A total of 827 patients who were investigated for unexplained syncope with head-up tilt test (HUT) and optional nitroglycerin provocation (Italian protocol) had blood samples collected while supine and after 3-minutes of HUT. Of these, 173 (20.9%) patients developed VVS during drug-free HUT, 161 of whom (males 44.7%; age 45±21 years) had complete data. We analyzed levels of epinephrine, norepinephrine, C-terminal pro–arginine vasopressin, C-terminal endothelin-1, and midregional fragments of pro–atrial natriuretic peptide and pro-adrenomedullin in relation to time from tilt-up to onset of VVS. We applied a linear regression model adjusted for age and sex. The mean time to syncope was 11±7 minutes. Older age (β=0.13; SE=0.03, P<0.001), higher supine systolic blood pressure (β=0.06; SE=0.03, P=0.02), and higher supine midregional fragment of pro-adrenomedullin predicted longer time to syncope (β=2.31; SE=0.77, P=0.003), whereas supine levels of other neurohormones were not associated with time to syncope. Among 151 patients who developed VVS later than 3 minutes of HUT, increase in epinephrine (β=−3.24; SE=0.78, P<0.001) and C-terminal pro–arginine vasopressin (β=−2.07; SE=0.61, P=0.001) at 3 minutes of HUT were related to shorter time to syncope. Conclusions: Older age, higher blood pressure, and higher level of pro-adrenomedullin are associated with later onset of VVS during tilt testing, whereas greater increase of tilt-induced epinephrine and vasopressin release correlate with shorter time to syncope.
KW - autonomic function
KW - biomarker
KW - neurocardiology
KW - syncope
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U2 - 10.1161/JAHA.119.012559
DO - 10.1161/JAHA.119.012559
M3 - Article
C2 - 31208249
AN - SCOPUS:85068425965
SN - 2047-9980
VL - 8
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 12
M1 - e012559
ER -