CLINICAL STUDY: SYNCOPE
Age and hemodynamic responses to tilt testing in those with syncope of unknown origin
Arvinder S. Kurbaan, MD*,*,
Timothy J. Bowker, MD ,
Nevin Wijesekera, MB,
Ann-Christine Franzén, RGN ,
David Heaven, MB,
Sujani Itty, MB and
Richard Sutton, DScMed, FACC
* Department of Cardiology, London Chest Hospital, LondonUnited Kingdom
Department of Cardiology, St Mary’s Hospital, LondonUnited Kingdom
Department of Cardiology, Chelsea & Westminster Hospital, London, United Kingdom
Manuscript received February 8, 2002;
revised manuscript received August 7, 2002,
accepted November 27, 2002.
* Reprint requests and correspondence: Dr. Arvinder S. Kurbaan, Department of Cardiology, London Chest Hospital, Bonner Road, London E2 9JX, United Kingdom.
a_kurbaan{at}hotmail.com
OBJECTIVES: We sought to determine whether there are age-related differences in vasovagal syncope.
BACKGROUND: In those with suspected vasovagal (neurocardiogenic) syncope, tilt testing demonstrates different hemodynamic responses. These responses may be age related, reflecting differing underlying pathophysiology.
METHODS: Using a two-stage tilt protocol with glyceryl trinitrate (GTN) provocation, 505 consecutive syncopal patients were studied. Their baseline characteristics and hemodynamic responses during both early and tilt-induced collapse were analyzed. Hemodynamic responses were classified using the VAsovagal Syncope International Study (VASIS) criteria: mixed, cardioinhibition, severe cardioinhibition/asystole, pure vasodepression, chronotropic incompetence, and excessive heart rate rise. Multivariate regression analyses were performed to determine the associations of the baseline clinical characteristics (including age) and the tilt-induced hemodynamic responses.
RESULTS: Thirty-three patients were unable to tolerate tilt testing. Age was independently associated with distinct responses during tilt. Chronotropic incompetence was predicted by increasing age (odds ratio [OR] 1.04, p < 0.0002). Younger age predicted an excessive heart rate rise (OR 0.97, p < 0.0005). Pure vasodepression was more common in the older group (>65 years; OR 29.5, p < 0.0001), whereas severe cardioinhibition was much less common in the older age group (OR 0.18, p < 0.0001).
CONCLUSIONS: There appear to be distinct pathophysiologies underlying vasovagal syncope in different age groups. Young people appear to have excessive cardiac and autonomic responses to stress, whereas older patients appear to have a more generalized cardiovascular decline, with attenuated cardiac and autonomic responses to stress.
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Abbreviations and Acronyms
| | BP | | blood pressure | | CI | | confidence interval | | GTN | | glyceryl trinitrate | | HR | | heart rate | | OR | | odds ratio | | VASIS | | VAsovagal Syncope International Study |
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