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Europace Advance Access published online on March 29, 2008
Europace, doi:10.1093/europace/eun067
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Do subjects with vasovagal syncope have subtle haemodynamic alterations during orthostatic stress?

Giuseppe Fucà, Maurizio Dinelli, Lorella Gianfranchi, Sabrina Bressan, Catia Lamborghini and Paolo Alboni*

Division of Cardiology and Arrhythmologic Centre, Ospedale Civile, 44042 Cento (FE), Italy

Aims: There are conflicting reports on the presence of subtle haemodynamic alterations during orthostatic stress in subjects with vasovagal syncope (VVS). The aim of the present study was to investigate whether young/middle-aged subjects with VVS show abnormal responses to orthostatic stress.

Methods and results: Four groups of subjects underwent tilt testing (TT) during the passive phase and, if negative, after nitroglycerin administration: Group I, 20 subjects with a history of syncope and positive passive TT; Group II, 23 subjects with a history of syncope and TT positive after nitroglycerin; Group III, 23 subjects with a history of syncope and negative TT; and Group IV, 20 normal control subjects. Heart rate, systolic, diastolic, and mean blood pressure, stroke volume, cardiac output, and total peripheral resistance were computed from pressure pulsations (Modelflow). The demographic data and the values of the haemodynamic variables in the supine position did not differ significantly among the four groups. The per cent changes in these variables did not differ significantly among the four groups after 2 and 5 min of TT and among Groups II, III, and IV, 2 min after nitroglycerin administration.

Conclusion: Young/middle-aged subjects with VVS have a normal measured haemodynamic response to orthostatic stress; therefore, the vasovagal reflex is not secondary to an impairment of the primary vasoconstrictive mechanism.

Key Words: Autonomic system, Haemodynamics, Syncope, Tilt testing, Vasovagal syncope

* Corresponding author. Tel: +39 051 6838251; fax: +39 051 6838471. E-mail address: p.alboni{at}ausl.fe.it

Manuscript submitted 4 December 2007. Accepted after revision 28 February 2008.


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