Vasovagal syncope is associated with poor prognosis in patients with left ventricular dysfunction

Assessment of cardiac function in syncopal children without organic causes

BACKGROUND

Syncope is a common problem in children and adolescents. However, a large proportion of syncope cases have no underlying cause.

PURPOSE

This study aimed to identify the factors affecting the severity of syncope using tissue Doppler imaging (TDI).

METHODS

This retrospective study included 61 children and adolescents with syncope who underwent echocardiography. The head-up-tilt test (HUT) was performed when there was a more severe syncopal event. We compared the echocardiographic findings between the execute HUT and nonexecute HUT, negative HUT result and positive HUT result, and normal electrocardiogram (ECG) and abnormal ECG groups. Data were analyzed using an unpaired t test post hoc analysis.

RESULTS

In the execute and nonexecute HUT groups, the odds ratios were 0.55 for medial E/E' (P=0.040) and 0.64 for lateral E/E' (P=0.049). Comparison of the results of the decreased, normal, and increased groups for lateral E/E' revealed a significant difference in the execution HUT and nonexecute HUT groups (overall, P=0.004; decreased vs. increased, P= 0.003; normal vs. increased, P=0.050).

CONCLUSION

Medial E/E' and lateral E/E' were decreased in patients with severe syncopal events. These findings suggest that the presence of left ventricular diastolic deterioration may cause hypoperfusion even in the absence of organic causes and, consequently, increase syncope severity and frequency. The TDI measured by echocardiography can be used as an index to predict syncope recurrence and/or severity.

Age Is a Predictor for the Syncope Recurrence in Elderly Vasovagal Syncope Patients With a Positive Head-Up Tilt Test

Background: Valid predictors of the syncope recurrence in vasovagal syncope (VVS) patients with a positive head-up tilt test (HUTT) are currently lacking. The goal of this study was to identify the predictive performance of age for the recurrence of syncope in VVS patients with a positive HUTT. Methods: In total, 175 VVS patients with a positive HUTT were observed for 6-32 months, and the recurrence of ≥1 syncope or typical pre-syncope prodromal episodes during follow-up was considered syncope recurrence. The population was divided into 2 groups, namely, a syncope recurrence group (44 patients) and a no syncope recurrence group (131 patients). The baseline clinical data, haemodynamic parameters, and classification of VVS on the HUTT were analyzed. Logistic regression was used to analyse the effect size and confidence interval for age. A receiver operating characteristic (ROC) curve analysis was used to assess the predictive performance and investigate the predictive value of age by the area under the curve (AUC). Results: The median age of the syncope recurrence group was older than that of the no syncope recurrence group [60.0 (47.8, 66.0) years>53.0 (43.0, 62.0) years], and there was a significant difference between the two groups (P < 0.05). The trend for syncope recurrence changed with advancing age, and the logistic regression model adjusted by sex showed that older patients had an increased risk of syncope recurrence in VVS with a positive HUTT [OR value: 1.03, 95% confidence interval (CI): 1.008-1.061, p < 0.05]. Age was a valid predictor for the recurrence of syncope in elderly VVS patients with a positive HUTT (AUC: 0.688; 95% CI: 0.598-0.777, p < 0.05). The cut-off value was 53.5 years, and the sensitivity and specificity were 72.7 and 52.7%, respectively. Conclusions: Age may be a valid predictor for syncope recurrence in elderly VVS patients with a positive HUTT. The rate of syncope recurrence increased with advancing age, especially in females.