dc.contributor
Institut Català de la Salut
dc.contributor
[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
dc.contributor
Vall d'Hebron Barcelona Hospital Campus
dc.contributor.author
Groppelli, Antonella
dc.contributor.author
Russo, Vincenzo
dc.contributor.author
Parente , Erika
dc.contributor.author
Comune, Angelo
dc.contributor.author
Rivasi, Giulia
dc.contributor.author
de Lange, Frederik
dc.contributor.author
Francisco Pascual, Jaume
dc.date.accessioned
2025-05-03T13:35:28Z
dc.date.available
2025-05-03T13:35:28Z
dc.date.issued
2025-03-12T13:35:20Z
dc.date.issued
2025-03-12T13:35:20Z
dc.date.issued
2025-03-01
dc.identifier
Groppelli A, Russo V, Parente E, Comune A, de Lange FJ, Rivasi G, et al. Mechanism of syncope: role of ambulatory blood pressure monitoring and cardiovascular autonomic function assessment. Eur Heart J. 2025 Mar 1;46(9):827-35.
dc.identifier
http://hdl.handle.net/11351/12755
dc.identifier
10.1093/eurheartj/ehae907
dc.identifier
001389471900001
dc.identifier.uri
http://hdl.handle.net/11351/12755
dc.description.abstract
Blood pressure; Carotid sinus massage; Syncope
dc.description.abstract
Presión arterial; Masaje del seno carotídeo; Síncope
dc.description.abstract
Pressió arterial; Massatge del sinus caròtide; Síncope
dc.description.abstract
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.
dc.description.abstract
This work was funded by BIBLIOSAN.
dc.format
application/pdf
dc.publisher
Oxford University Press
dc.relation
European Heart Journal;46(9)
dc.relation
https://doi.org/10.1093/eurheartj/ehae907
dc.rights
Attribution 4.0 International
dc.rights
http://creativecommons.org/licenses/by/4.0/
dc.rights
info:eu-repo/semantics/openAccess
dc.subject
Síncope (Patologia) - Diagnòstic
dc.subject
Monitoratge ambulatori de pressió sanguínia
dc.subject
DISEASES::Nervous System Diseases::Neurologic Manifestations::Neurobehavioral Manifestations::Consciousness Disorders::Unconsciousness::Syncope
dc.subject
Other subheadings::Other subheadings::/diagnosis
dc.subject
ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Diagnosis::Diagnostic Techniques and Procedures::Diagnostic Techniques, Cardiovascular::Blood Pressure Determination::Blood Pressure Monitoring, Ambulatory
dc.subject
ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Diagnosis::Diagnostic Techniques and Procedures::Physical Examination::Vital Signs::Heart Rate
dc.subject
ENFERMEDADES::enfermedades del sistema nervioso::manifestaciones neurológicas::manifestaciones neuroconductuales::trastornos de la conciencia::inconsciencia::síncope
dc.subject
Otros calificadores::Otros calificadores::/diagnóstico
dc.subject
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
dc.subject
TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::diagnóstico::técnicas y procedimientos diagnósticos::exploración física::signos vitales::frecuencia cardíaca
dc.title
Mechanism of syncope: role of ambulatory blood pressure monitoring and cardiovascular autonomic function assessment
dc.type
info:eu-repo/semantics/article
dc.type
info:eu-repo/semantics/publishedVersion
