Sistema de Salut de Catalunya
Institut Català de la Salut
[Groppelli A] Department of Cardiology, IRCCS Istituto Auxologico Italiano, Faint and Fall Research Centre, S. Luca Hospital, Milano, Italy. [Russo V, Parente E, Comune A] Department of Translational Medical Sciences, Cardiology and Syncope Unit, University of Campania ‘Luigi Vanvitelli’—Monaldi Hospital, Piazzale E. Ruggeri, Naples, Italy. [de Lange FJ] Department of Clinical and Experimental Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, Heart Centre, Amsterdam, The Netherlands. [Rivasi G] Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy. [Francisco-Pascual J] Unitat d’Arrítmies, Servei de Cardiologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain. CIBER-CV, Barcelona, Spain
Vall d'Hebron Barcelona Hospital Campus
2025-03-12T13:35:20Z
2025-03-12T13:35:20Z
2024
2025-03-01
Blood pressure; Carotid sinus massage; Syncope
Presión arterial; Masaje del seno carotídeo; Síncope
Pressió arterial; Massatge del sinus caròtide; Síncope
Background and Aims Identifying the haemodynamic mechanism of autonomic syncope is the essential pre-requisite for effective and personalized therapy aimed at preventing recurrences. The present study assessed the diagnostic efficacy of a two-step assessment. Methods Multicentre prospective, cross-sectional, observational study. Patients affected by severe autonomic syncope underwent a two-step assessment including 24-h ambulatory blood pressure monitoring and short cardiovascular autonomic function assessment (SCAFA). SCAFA consisted of carotid sinus massage (CSM), performed in patients ≥40 years old, a passive standing test, and a ‘fast’ head-up tilt test scheduled sequentially during one session on a tilt table. Results The study population consisted of 333 patients, 102 ≤ 40 years old and 231 > 40 years old. Any positive response was observed in 298 (89%) patients (92 [92%] in younger and 134 [89%] in older), with hypotensive phenotype accounting for 226 (68%), bradycardic phenotype for 21 (6%) and mixed phenotype for 51 (15%) of cases. The mean duration of the SCAFA procedure was 25 (IQR 20–32) min. Ambulatory blood pressure monitoring, CSM, passive standing, and head-up tilt test were positive in 60%, 15%, 3%, and 71% of patients, respectively. More than one test was positive in 51% and 49% of patients ≤40 and >40 years, respectively. Large inter-centre variability of CSM positivity rate, which remained significant after adjustment for demographic and clinical variables, was observed (P = .003). Conclusions The standardized 2STEPS protocol offers an easy-to-perform and time-saving diagnostic work-up allowing identification of the haemodynamic mechanism of loss of consciousness in most patients with autonomic syncope. This protocol provides the necessary background for a personalized mechanism-specific therapy.
This work was funded by BIBLIOSAN.
Article
Published version
English
Síncope (Patologia) - Diagnòstic; Cor - Batecs; Monitoratge ambulatori de pressió sanguínia; DISEASES::Nervous System Diseases::Neurologic Manifestations::Neurobehavioral Manifestations::Consciousness Disorders::Unconsciousness::Syncope; Other subheadings::Other subheadings::/diagnosis; ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Diagnosis::Diagnostic Techniques and Procedures::Diagnostic Techniques, Cardiovascular::Blood Pressure Determination::Blood Pressure Monitoring, Ambulatory; ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Diagnosis::Diagnostic Techniques and Procedures::Physical Examination::Vital Signs::Heart Rate; ENFERMEDADES::enfermedades del sistema nervioso::manifestaciones neurológicas::manifestaciones neuroconductuales::trastornos de la conciencia::inconsciencia::síncope; Otros calificadores::Otros calificadores::/diagnóstico; TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::diagnóstico::técnicas y procedimientos diagnósticos::técnicas diagnósticas cardiovasculares::determinación de la presión arterial::monitorización ambulatoria de la presión arterial; TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::diagnóstico::técnicas y procedimientos diagnósticos::exploración física::signos vitales::frecuencia cardíaca
Oxford University Press
European Heart Journal;46(9)
https://doi.org/10.1093/eurheartj/ehae907
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
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