Are Compression Stockings an Effective Treatment for Orthostatic Presyncope?

Abstract

BackgroundSyncope, or fainting, affects approximately 6.2% of the population, and is associated with significant comorbidity. Many syncopal events occur secondary to excessive venous pooling and capillary filtration in the lower limbs when upright. As such, a common approach to the management of syncope is the use of compression stockings. However, research confirming their efficacy is lacking. We aimed to investigate the effect of graded calf compression stockings on orthostatic tolerance.Methodology/Principal FindingsWe evaluated orthostatic tolerance (OT) and haemodynamic control in 15 healthy volunteers wearing graded calf compression stockings compared to two placebo stockings in a randomized, cross-over, double-blind fashion. OT (time to presyncope, min) was determined using combined head-upright tilting and lower body negative pressure applied until presyncope. Throughout testing we continuously monitored beat-to-beat blood pressures, heart rate, stroke volume and cardiac output (finger plethysmography), cerebral and forearm blood flow velocities (Doppler ultrasound) and breath-by-breath end tidal gases. There were no significant differences in OT between compression stocking (26.0±2.3 min) and calf (29.3±2.4 min) or ankle (27.6±3.1 min) placebo conditions. Cardiovascular, cerebral and respiratory responses were similar in all conditions. The efficacy of compression stockings was related to anthropometric parameters, and could be predicted by a model based on the subject's calf circumference and shoe size (r = 0.780, p = 0.004).Conclusions/SignificanceThese data question the use of calf compression stockings for orthostatic intolerance and highlight the need for individualised therapy accounting for anthropometric variables when considering treatment with compression stockings.

2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society

“…305,[307][308][309][310][311][312] There is no evidence that syncope in patients with short-QT pattern is a risk factor for cardiac arrest in the absence of documented VT or VF. Therefore, ICD implantation may be limited to patients with suspected arrhythmic syncope, particularly in the presence of a family history of SCD.…”

Orthostatic Hypotension

“…Limb and abdomen compression improves orthostatic tolerance in up to 40% of symptomatic patients. The recommended compression pressure is 30 to 50 mm Hg for leg compression and 20 to 30 mm Hg for the abdomen.However, leg compression alone is not as effective as compression of the abdomen because the venous compartment of the lower limbs is smaller than that of the splanchnic region(75,76); therefore, "the higher, the better" principle should be applied. The main disadvantage of this method is that compression garments are inconvenient to put on and wear, particularly for older and disabled patients and during the summer season.…”

Tilt Testing with Combined Lower Body Negative Pressure: a "Gold Standard" for Measuring Orthostatic Tolerance

“…This approach provokes presyncope in almost all subjects (allowing for symptom recognition in patients with syncope), while discriminating between patients with syncope and healthy controls, with a specificity of 92%, sensitivity of 85%, and repeatability of 1.1±0.6 min 16,17 . This allows not only diagnosis and pathophysiological assessment [19][20][21][22] , but also the evaluation of treatments for orthostatic intolerance due to its high repeatability [23][24][25][26][27][28][29][30] . For these reasons, we argue this should be the "gold standard" for orthostatic stress testing, and accordingly this will be the method described in this paper.…”