Michele Brignole1, Giulia Rivasi2, Richard Sutton3, Rose Anne Kenny4, Carlos A Morillo5, Robert Sheldon5, Satish R Raj5, Andrea Ungar2, Raffaello Furlan6, Gert van Dijk7, Mohamed Hamdan8, Viktor Hamrefors9,10, Gunnar Engström9, Chloe Park11, Davide Soranna12, Antonella Zambon12,13, Gianfranco Parati1,14, Artur Fedorowski9,15. 1. IRCCS Istituto Auxologico Italiano, Faint & Fall Programme, Ospedale San Luca, Milan. 2. Syncope Unit, Division of Geriatrics and Intensive Care Unit, University of Florence and Careggi Hospital, Florence, Italy. 3. National Heart and Lung Institute, Imperial College, Hammersmith Hospital Campus, Ducane Road, London, UK. 4. Chair Medical Gerontology, Syncope and Falls Unit, School of Medicine, St James Hospital and Trinity College, Dublin, Ireland. 5. Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada. 6. Internal Medicine, Humanitas Clinical and Research Center-IRCCS, Department of Biomedical Sciences, Humanitas University, Rozzano, Italy. 7. Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands. 8. Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA. 9. Department of Clinical Sciences, Lund University. 10. Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden. 11. MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College, London, UK. 12. IRCCS Istituto Auxologico Italiano, Biostatistics Unit. 13. Department of Statistics and quantitative methods, University of Milano-Bicocca. 14. Department of Medicine and Surgery, University of Milano Bicocca and IRCCS Istituto Auxologico Italiano, Ospedale San Luca, Milan, Italy. 15. Department of Cardiology, Skåne University Hospital, Malmö, Sweden.
Abstract
BACKGROUND: We hypothesized that cardiovascular physiology differs in reflex syncope patients compared with the general population, predisposing such individuals to vasovagal reflex. METHODS: In this multicohort cross-sectional study, we compared aggregate data of resting SBP, DBP, pulse pressure (PP) and heart rate (HR), collected from six community-based cohort studies (64 968 observations) with those from six databases of reflex syncope patients (6516 observations), subdivided by age decades and sex. RESULTS: Overall, in male individuals with reflex syncope, SBP (-3.4 mmHg) and PP (-9.2 mmHg) were lower and DBP (+2.8 mmHg) and HR (+5.1 bpm) were higher than in the general population; the difference in SBP was higher at ages above 60 years. In female individuals, PP (-6.0 mmHg) was lower and DBP (+4.7 mmHg) and HR (+4.5 bpm) were higher than in the general population; differences in SBP were less pronounced, becoming evident only above 60 years. Compared with male individuals, SBP in female individuals exhibited slower increase until age 40 years, and then demonstrated steeper increase that continued throughout remaining life. CONCLUSION: The patients prone to reflex syncope demonstrate a different resting cardiovascular haemodynamic profile as compared with a general population, characterized by lower SBP and PP, reflecting reduced venous return and lower stroke volume, and a higher HR and DBP, suggesting the activation of compensatory mechanisms. Our data contribute to a better understanding why some individuals with similar demographic characteristics develop reflex syncope and others do not. VIDEO ABSTRACT: http://links.lww.com/HJH/B580.
BACKGROUND: We hypothesized that cardiovascular physiology differs in reflex syncopepatients compared with the general population, predisposing such individuals to vasovagal reflex. METHODS: In this multicohort cross-sectional study, we compared aggregate data of resting SBP, DBP, pulse pressure (PP) and heart rate (HR), collected from six community-based cohort studies (64 968 observations) with those from six databases of reflex syncopepatients (6516 observations), subdivided by age decades and sex. RESULTS: Overall, in male individuals with reflex syncope, SBP (-3.4 mmHg) and PP (-9.2 mmHg) were lower and DBP (+2.8 mmHg) and HR (+5.1 bpm) were higher than in the general population; the difference in SBP was higher at ages above 60 years. In female individuals, PP (-6.0 mmHg) was lower and DBP (+4.7 mmHg) and HR (+4.5 bpm) were higher than in the general population; differences in SBP were less pronounced, becoming evident only above 60 years. Compared with male individuals, SBP in female individuals exhibited slower increase until age 40 years, and then demonstrated steeper increase that continued throughout remaining life. CONCLUSION: The patients prone to reflex syncope demonstrate a different resting cardiovascular haemodynamic profile as compared with a general population, characterized by lower SBP and PP, reflecting reduced venous return and lower stroke volume, and a higher HR and DBP, suggesting the activation of compensatory mechanisms. Our data contribute to a better understanding why some individuals with similar demographic characteristics develop reflex syncope and others do not. VIDEO ABSTRACT: http://links.lww.com/HJH/B580.
Authors: Kenneth A Mayuga; Artur Fedorowski; Fabrizio Ricci; Rakesh Gopinathannair; Jonathan Walter Dukes; Christopher Gibbons; Peter Hanna; Dan Sorajja; Mina Chung; David Benditt; Robert Sheldon; Mirna B Ayache; Hiba AbouAssi; Kalyanam Shivkumar; Blair P Grubb; Mohamed H Hamdan; Stavros Stavrakis; Tamanna Singh; Jeffrey J Goldberger; James A S Muldowney; Mark Belham; David C Kem; Cem Akin; Barbara K Bruce; Nicole E Zahka; Qi Fu; Erik H Van Iterson; Satish R Raj; Fetnat Fouad-Tarazi; David S Goldstein; Julian Stewart; Brian Olshansky Journal: Circ Arrhythm Electrophysiol Date: 2022-09-08