Jean-Claude Deharo1, Regis Guieu2, Alexis Mechulan1, Eric Peyrouse1, Nathalie Kipson3, Jean Ruf3, Victoria Gerolami3, Gianluigi Devoto4, Vanna Marrè4, Michele Brignole5. 1. Department of Cardiology, Timone University Hospital, Marseille, France. 2. Laboratory of Biochemistry and Molecular Biology, Timone University Hospital, Marseille, France; Laboratory of Biochemistry and Molecular Biology, Université de la Méditerranée, Ministère de la Défense, Marseille, France. 3. Laboratory of Biochemistry and Molecular Biology, Université de la Méditerranée, Ministère de la Défense, Marseille, France. 4. Laboratory of Biochemistry and Molecular Biology, Ospedali del Tigullio, Lavagna, Italy. 5. Department of Cardiology, Arrhythmologic Centre, Ospedali del Tigullio, Lavagna, Italy. Electronic address: mbrignole@asl4.liguria.it.
Abstract
OBJECTIVES: This study sought to investigate the clinical and laboratory findings of patients affected by sudden-onset syncope without prodromes who had a normal heart and normal electrocardiogram. BACKGROUND: The pathophysiology of syncope in these patients is uncertain. METHODS: We compared the clinical and laboratory findings of 15 patients with sudden-onset syncope without prodromes who had a normal heart and normal electrocardiogram (the study group) with those of 31 patients with established vasovagal syncope (VVS). RESULTS: The patients in the study group were older than those with VVS (age 61 ± 12 years vs. 46 ± 17 years) and had a history of fewer episodes of syncope (median of 2 [interquartile range [IQR]: 1 to 2.5] vs. 9 [IQR: 4 to 15] years) that were of more recent onset (median of 1 [IQR: 0 to 1] vs. 10.5 [IQR: 3.3 to 27] years). The study group had lower median baseline adenosine plasmatic levels than the VVS group (0.25 μmol/l [95% confidence interval: 0.10 to 1.51] vs. 0.85 μmol/l [95% confidence interval: 0.32 to 2.80]). On receiver-operating characteristic curve analysis, the adenosine plasmatic level of ≤0.36 best discriminated between groups, displaying 73% sensitivity and 93% specificity. Tilt table testing was more frequently positive in patients with VVS than in the study group (74% vs. 33%). A similarly high positivity rate of adenosine/adenosine triphosphate testing was found in both groups. CONCLUSIONS: Common clinical features and a low adenosine plasmatic level define a distinct form of syncope, distinguish it from VVS, and suggest a causal role of the adenosine pathway.
OBJECTIVES: This study sought to investigate the clinical and laboratory findings of patients affected by sudden-onset syncope without prodromes who had a normal heart and normal electrocardiogram. BACKGROUND: The pathophysiology of syncope in these patients is uncertain. METHODS: We compared the clinical and laboratory findings of 15 patients with sudden-onset syncope without prodromes who had a normal heart and normal electrocardiogram (the study group) with those of 31 patients with established vasovagal syncope (VVS). RESULTS: The patients in the study group were older than those with VVS (age 61 ± 12 years vs. 46 ± 17 years) and had a history of fewer episodes of syncope (median of 2 [interquartile range [IQR]: 1 to 2.5] vs. 9 [IQR: 4 to 15] years) that were of more recent onset (median of 1 [IQR: 0 to 1] vs. 10.5 [IQR: 3.3 to 27] years). The study group had lower median baseline adenosine plasmatic levels than the VVS group (0.25 μmol/l [95% confidence interval: 0.10 to 1.51] vs. 0.85 μmol/l [95% confidence interval: 0.32 to 2.80]). On receiver-operating characteristic curve analysis, the adenosine plasmatic level of ≤0.36 best discriminated between groups, displaying 73% sensitivity and 93% specificity. Tilt table testing was more frequently positive in patients with VVS than in the study group (74% vs. 33%). A similarly high positivity rate of adenosine/adenosine triphosphate testing was found in both groups. CONCLUSIONS: Common clinical features and a low adenosine plasmatic level define a distinct form of syncope, distinguish it from VVS, and suggest a causal role of the adenosine pathway.
Authors: Robert S Sheldon; Blair P Grubb; Brian Olshansky; Win-Kuang Shen; Hugh Calkins; Michele Brignole; Satish R Raj; Andrew D Krahn; Carlos A Morillo; Julian M Stewart; Richard Sutton; Paola Sandroni; Karen J Friday; Denise Tessariol Hachul; Mitchell I Cohen; Dennis H Lau; Kenneth A Mayuga; Jeffrey P Moak; Roopinder K Sandhu; Khalil Kanjwal Journal: Heart Rhythm Date: 2015-05-14 Impact factor: 6.343
Authors: Antonella Groppelli; Michele Brignole; Mohamed Chefrour; Marguerite Gastaldi; Farid El Oufir; Jean Claude Deharo; Gianfranco Parati; Régis Guieu Journal: Front Cardiovasc Med Date: 2022-06-17