Research Article
Year 2018,
Volume: 21 Issue: 2, 169 - 173, 19.08.2018
Conclusion: While left ventricular
functions are not affected, right ventricular contraction is more powerful in
patients who experience syncope during HUTT.
Abstract
Introduction:
Left
ventricular hyper contractility has been thought to have a major role at early
phases of vasovagal syncope. However the right ventricular function during
syncope has not been delineated clearly. The present study evaluated the right
myocardial contractility in patients who experienced vasovagal syncope during
head-up tilt test (HUTT).
Patients
and Methods: A total of 89 Patients, who experienced syncope between
January 2012 and March 2014, were included in the study. All the patients
underwent HUTT and were followed by transthoracic echocardiography.
Results: Fifty
patients experienced syncope during HUTT. There was no significant difference
between the patients, who experienced syncope versus who did not, in terms of
gender, age, ejection fraction (p> 0.05). Mitral lateral annular systolic
(s’) velocity (14 ± 3.8 vs. 13.3 ± 3.6; p= 0.625), septal annular s’ velocity
(11 ± 3.7 vs. 10.3 ± 2; p= 0.951) were similar following HUTT in patients with
and without syncope respectively. However, tricuspid valve lateral annular s’
velocity after tilt testing was higher in patients, who experienced syncope (17
± 2.7 vs. 15.1 ± 3.0; p= 0.003).
Conclusion: While left ventricular
functions are not affected, right ventricular contraction is more powerful in
patients who experience syncope during HUTT.
References
- 1. Moya A, Sutton R, Ammirati F, Blanc JJ, Brignole M, Dahm JB, et al. Guidelines for the diagnosis and management of syncope (version 2009). European Heart J 2009;30: 2631-71.
- 2. Blanc JJ, L’Her C, Touiza A, Garo B, L’Her E, Mansourati J. Prospective evaluation and outcome of patients admitted for syncope over a 1 year period. Eur Heart J 2002;23:815-20.
- 3. Alshekhlee A, Shen WK, Mackall J, Chelimsky TC. Incidence and mortality rates of syncope in the United States. Am J Med 2009;122:181-8.
- 4. Vigar S, Bradley D, Shen W. Syncope units: impact on patient care and health related costs. Cardiol Clin 2013;31:39-49.
- 5. Brignole M, Menozzi C, Bartoletti A, Giada F, Lagi A, Ungar A, et al. A new management of syncope: prospective systematic guideline-based evaluation of patients referred urgently to general hospitals. Eur Heart J 2006;27:76-82.
- 6. Krediet CT, van Dijk N, Linzer M, van Lieshout JJ, Wieling W. Management of vasovagal syncope: controlling or aborting faints by leg crossing and muscle tensing. Circulation 2002;106:1684-9.
- 7. Kapoor WN. Syncope. N Engl J Med 2000;343:1856-62.
- 8. Zaqqa M, Massumi A. Neurally mediated syncope. Tex Heart Institute J 2000;27:268-72.
- 9. Benditt DG, Sakaguchi S, Schultz JJ, Remole S, Adler S, Lurie KG. Diagnostic considerations and the role of tilt table testing. Cardiol Rev 1993;1:146-56.
- 10. Brignole M, Menozzi C, Del Rosso A, Costa S, Gaggioli G, Bottoni N, et al. New classification of haemodynamics of vasovagal syncope: beyond the VASIS classification Analysis of the pre-syncopal phase of the tilt test without and with nitroglycerin challenge. Vasovagal Syncope International Study. Europace 2000;2:66-76.
- 11. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al; American Society of Echocardiography’s Nomenclature and Standards Committee; Task Force on Chamber Quantification; American College of Cardiology Echocardiography Committee; American Heart Association; European Association of Echocardiography, European Society of Cardiology. Recommendations for chamber quantification. Eur J Echocardiogr 2006;7:79-108.
- 12. Shalev Y, Gal R, Tchou PJ, Anderson AJ, Avitall B, Akhtar M, et al. Echocardiographic demonstration of decreased left ventricular dimensions and vigorous myocardial contraction during syncope induced by head-up tilt. J Am Coll Cardiol 1991;18:746-51.
- 13. Mosqueda-Garcia R, Fernandez-Violante R, Tank J, Snell M, Cunningham G, Furlan R. Yohimbine in neurally mediated syncope. Pathophysiological implications. J Clin Invest 1998;102:1824-30.
- 14. Mosqueda-Garcia R, Furlan R, Fernandez-Violante R, Desai T, Snell M, Jarai Z. Sympathetic and baroreceptor reflex function in neurally mediated syncope evoked by tilt. J Clin Invest1997;99:2736-44.
- 15. Ellenbogen KA, Morillo CA, Wood MA, Gilligan DM, Eckberg DL, Smith ML. Neural monitoring of vasovagal syncope. Pacing Clin Electrophysiol 1997;20:788-94.
- 16. Mosqueda-Garcia R, Furlan R, Tank J, Fernandez-Violante R. The elusive pathophysiology of neurally mediated syncope. Circulation 2000;102:2898-906.
- 17. Forleo C, Guida P, Iacoviello M, Resta M, Monitillo F, Sorrentino S, et al. Head-up tilt testing for diagnosing vasovagal syncope: A meta-analysis. Int J Cardiol 2013;168:27-35.
- 18. Moon J, Kim H, Kim JY, Chung S, Choi EY, Min PK. Left ventricular hypercontractility immediately after tilting triggers a disregulated cardioinhibitory reaction in vasovagal syncope: echocardiographic evaluation during the head-up tilt test. Cardiology 2010;117:118-23.
- 19. Goel R, Caracciolo G, Wilansky S, Scott LR, Narula J, Sengupta PP. Effect of head-up tilt-table testing on left ventricular longitudinal strain in patients with neurogenic syncope. Am J Cardiol 2013;112:1252-7.
- 20. Appleton CP, Jensen JL, Hatle LK, Oh JK. Doppler evaluation of left and right ventricular diastolic function: a technical guide for obtaining optimal flow velocity recordings. J Am Soc Echocardiogr 1997;10:271-91.
- 21. Gulati VK, Katz WE, Follansbee WP, Gorcsan J. Mitral annular descent velocity by tissue Doppler echocardiography as an index of global left ventricular function. Am J Cardiol 1996;77:979-84.
- 22. Yamada H, Oki T, Tabata T, Iuchi A, Ito S. Assessment of left ventricular systolic wall motion velocity with pulsed tissue Doppler imaging: comparison with peak dP/dt of the left ventricular pressure curve. J Am Soc Echocardiogr 1998;11:442-9.
- 23. Folino AF, Russo G, Buja G, Iliceto S. Contribution of decreased atrial function in the pathogenesis of neurally mediated syncope. Am J Cardiol 2006;97:1017-24.
- 24. Mangin L, Kobeissi A, Lelouche D, Dhérouville TY, Mansier P, Swynghedauw B, et al. Simultaneous analysis of heart rate variability and myocardial contractility during head-up tilt in patients with vasovagal syncope. J Cardiovasc Electrophysiol 2001;12:639-44.
Year 2018,
Volume: 21 Issue: 2, 169 - 173, 19.08.2018
Sonuç: Eğik masa testinde senkop
gelişen hastalarda sol ventrikül fonksiyonları değişmezken sağ ventrikül
kontraksiyonunda artış gözlenmiştir.
Abstract
Giriş: Nörojenik senkopun erken safhasında sol ventrikül
kontraktilite artışının önemli rolü olduğu düşünülmektedir. Fakat senkop
esnasında sağ ventrikül fonksiyonu net olarak ortaya konmamıştır. Bu çalışmada
eğik masa testinde (EMT) nörojenik senkop geçiren hastalarda sağ ventrikül
fonksiyonu değerlendirilmiştir.
Hastalar ve Yöntem: Ocak 2016 ve Mart 2017 tarihleri
arasında senkop geçiren 89 hasta çalışmaya dahil edilmiştir. Tüm hastalara EMT
ve ardından transtorasik ekokardiyografi uygulanmıştır.
Bulgular: Eğik masa testinde 50 hastada senkop gelişmiştir. Senkop
gelişen ve gelişmeyen hastalarda
cinsiyet, yaş ve ejeksiyon fraksiyonu açısından fark gözlenmemiştir (p> 0.05). Mitral lateral anüler sistolik (s’)
velositesi (14 ± 3.8’e karşı 13.3 ± 3.6
p= 0.625), septal anuler s’ velositesi (11 ± 3.7’ye karşı 10.3 ± 2 p=
0.951) senkop gelişen ve gelişmeyen hastalarda benzer izlenmiştir. Fakat senkop
geçiren hastalarda triküspit lateral anüler s’ velositesi daha yüksek
saptanmıştır (17 ± 2.7’e karşı 15.1 ± 3.0, p= 0.003).
Sonuç: Eğik masa testinde senkop
gelişen hastalarda sol ventrikül fonksiyonları değişmezken sağ ventrikül
kontraksiyonunda artış gözlenmiştir.
References
- 1. Moya A, Sutton R, Ammirati F, Blanc JJ, Brignole M, Dahm JB, et al. Guidelines for the diagnosis and management of syncope (version 2009). European Heart J 2009;30: 2631-71.
- 2. Blanc JJ, L’Her C, Touiza A, Garo B, L’Her E, Mansourati J. Prospective evaluation and outcome of patients admitted for syncope over a 1 year period. Eur Heart J 2002;23:815-20.
- 3. Alshekhlee A, Shen WK, Mackall J, Chelimsky TC. Incidence and mortality rates of syncope in the United States. Am J Med 2009;122:181-8.
- 4. Vigar S, Bradley D, Shen W. Syncope units: impact on patient care and health related costs. Cardiol Clin 2013;31:39-49.
- 5. Brignole M, Menozzi C, Bartoletti A, Giada F, Lagi A, Ungar A, et al. A new management of syncope: prospective systematic guideline-based evaluation of patients referred urgently to general hospitals. Eur Heart J 2006;27:76-82.
- 6. Krediet CT, van Dijk N, Linzer M, van Lieshout JJ, Wieling W. Management of vasovagal syncope: controlling or aborting faints by leg crossing and muscle tensing. Circulation 2002;106:1684-9.
- 7. Kapoor WN. Syncope. N Engl J Med 2000;343:1856-62.
- 8. Zaqqa M, Massumi A. Neurally mediated syncope. Tex Heart Institute J 2000;27:268-72.
- 9. Benditt DG, Sakaguchi S, Schultz JJ, Remole S, Adler S, Lurie KG. Diagnostic considerations and the role of tilt table testing. Cardiol Rev 1993;1:146-56.
- 10. Brignole M, Menozzi C, Del Rosso A, Costa S, Gaggioli G, Bottoni N, et al. New classification of haemodynamics of vasovagal syncope: beyond the VASIS classification Analysis of the pre-syncopal phase of the tilt test without and with nitroglycerin challenge. Vasovagal Syncope International Study. Europace 2000;2:66-76.
- 11. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al; American Society of Echocardiography’s Nomenclature and Standards Committee; Task Force on Chamber Quantification; American College of Cardiology Echocardiography Committee; American Heart Association; European Association of Echocardiography, European Society of Cardiology. Recommendations for chamber quantification. Eur J Echocardiogr 2006;7:79-108.
- 12. Shalev Y, Gal R, Tchou PJ, Anderson AJ, Avitall B, Akhtar M, et al. Echocardiographic demonstration of decreased left ventricular dimensions and vigorous myocardial contraction during syncope induced by head-up tilt. J Am Coll Cardiol 1991;18:746-51.
- 13. Mosqueda-Garcia R, Fernandez-Violante R, Tank J, Snell M, Cunningham G, Furlan R. Yohimbine in neurally mediated syncope. Pathophysiological implications. J Clin Invest 1998;102:1824-30.
- 14. Mosqueda-Garcia R, Furlan R, Fernandez-Violante R, Desai T, Snell M, Jarai Z. Sympathetic and baroreceptor reflex function in neurally mediated syncope evoked by tilt. J Clin Invest1997;99:2736-44.
- 15. Ellenbogen KA, Morillo CA, Wood MA, Gilligan DM, Eckberg DL, Smith ML. Neural monitoring of vasovagal syncope. Pacing Clin Electrophysiol 1997;20:788-94.
- 16. Mosqueda-Garcia R, Furlan R, Tank J, Fernandez-Violante R. The elusive pathophysiology of neurally mediated syncope. Circulation 2000;102:2898-906.
- 17. Forleo C, Guida P, Iacoviello M, Resta M, Monitillo F, Sorrentino S, et al. Head-up tilt testing for diagnosing vasovagal syncope: A meta-analysis. Int J Cardiol 2013;168:27-35.
- 18. Moon J, Kim H, Kim JY, Chung S, Choi EY, Min PK. Left ventricular hypercontractility immediately after tilting triggers a disregulated cardioinhibitory reaction in vasovagal syncope: echocardiographic evaluation during the head-up tilt test. Cardiology 2010;117:118-23.
- 19. Goel R, Caracciolo G, Wilansky S, Scott LR, Narula J, Sengupta PP. Effect of head-up tilt-table testing on left ventricular longitudinal strain in patients with neurogenic syncope. Am J Cardiol 2013;112:1252-7.
- 20. Appleton CP, Jensen JL, Hatle LK, Oh JK. Doppler evaluation of left and right ventricular diastolic function: a technical guide for obtaining optimal flow velocity recordings. J Am Soc Echocardiogr 1997;10:271-91.
- 21. Gulati VK, Katz WE, Follansbee WP, Gorcsan J. Mitral annular descent velocity by tissue Doppler echocardiography as an index of global left ventricular function. Am J Cardiol 1996;77:979-84.
- 22. Yamada H, Oki T, Tabata T, Iuchi A, Ito S. Assessment of left ventricular systolic wall motion velocity with pulsed tissue Doppler imaging: comparison with peak dP/dt of the left ventricular pressure curve. J Am Soc Echocardiogr 1998;11:442-9.
- 23. Folino AF, Russo G, Buja G, Iliceto S. Contribution of decreased atrial function in the pathogenesis of neurally mediated syncope. Am J Cardiol 2006;97:1017-24.
- 24. Mangin L, Kobeissi A, Lelouche D, Dhérouville TY, Mansier P, Swynghedauw B, et al. Simultaneous analysis of heart rate variability and myocardial contractility during head-up tilt in patients with vasovagal syncope. J Cardiovasc Electrophysiol 2001;12:639-44.
There are 24 citations in total.
Details
| Primary Language | English |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Original Investigations |
| Authors | |
| Publication Date | August 19, 2018 |
| Published in Issue | Year 2018 Volume: 21 Issue: 2 |
