Effect of Head-Up Tilt-Table Testing on Left Ventricular Longitudinal Strain in Patients With Neurocardiogenic Syncope

Goel, Ramil; Caracciolo, Giuseppe; Wilansky, Susan; Scott, Luis R.; Narula, Jagat; Sengupta, Partho P.

doi:10.1016/j.amjcard.2013.06.020

Cited by 8 publications

(12 citation statements)

References 24 publications

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“…On the other hand, our findings are counterintuitive in the light of the “ventricular theory” in that we did not measure an increase but a decrease in LV contractility in patients with NS and a positive HUTT response. This, however, apart from the fact that the ventricular hypothesis is far from being established conclusively, is in agreement with a similarly performed study by Goel et al, who report attenuated resting LV strain in HUTT+ patients and conclude that – other than previously believed – increased resting LV contractility is not a prerequisite for the development of NS [ 17 ]. Notably, even though the authors have measured a similar phenomenon as we did in this study, their study bares significant technical limitations which gives incremental value to our observations.…”

Section: Discussionsupporting

confidence: 90%

“…It has been successfully used to detect subclinical myocardial dysfunction in a variety of clinical settings such as arterial hypertension [ 13 ], systemic inflammatory disease [ 14 ], diabetes mellitus [ 15 ] and short-term alterations of glucose metabolism [ 16 ]. In 2013, the “ventricular theory” was fundamentally questioned by Goel et al as they reported a paradoxical decrease of LV strain in adults with neurally mediated syncope and a positive head-up tilt-table (HUTT) exam utilizing STE [ 17 ]. However, echocardiographic assessment of cardiac strain was not performed at the same time as tilt-testing and LV strain rate – which, other than strain, is less dependent of cardiac loading conditions and therefore a better parameter to reflect LV contractility [ 18 ] - was not measured.…”

Section: Introductionmentioning

confidence: 99%

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Novel functional advanced echocardiography for the assessment of myocardial mechanics in children with neurocardiogenic syncope – a blinded prospective speckle tracking head-up tilt-table challenge study

Hensel

Roskopf

Schneyder

et al. 2018

BMC Cardiovasc Disord

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BackgroundData on left ventricular (LV) function in patients with neurocardiogenic syncope (NS) is conflicting in adults and lacking in children. The aim of this study was to analyze LV myocardial performance in children with NS at rest and during head-up tilt-table (HUTT) testing.MethodsThis is the first study to combine HUTT and speckle-tracking echocardiography (STE) in children with NS. 43 consecutive normotensive pediatric patients with NS (mean age 13.9 ± 2.6 years, 51% female) and 41 sex- and age-matched healthy controls were included in the study. The study groups consisted of 21 patients with a positive HUTT reaction (HUTT+) and 22 with a negative HUTT reaction (HUTT-). STE was used to analyze peak systolic LV myocardial strain and strain rate.ResultsConventional echocardiographic parameters were similar in all analyzed groups. When compared to healthy controls, children with NS had depressed levels of circumferential strain rate (p = 0.032) and significantly depressed longitudinal strain rate (p < 0.001) at rest. Interestingly, during HUTT testing LV global strain and strain rate were similar in both groups. LV strain rate was lowest in HUTT+ followed by HUTT- and control subjects both at rest and during HUTT.ConclusionsResting LV longitudinal strain rate is attenuated in children with NS, especially in those with a positive HUTT response. This is further evidence that NS patients feature altered cardiac mechanics rendering them prone to vasovagal perturbations that can ultimately result in collapse.Trial registrationWitten/Herdecke University ethics committee clinical study number: UWH-73-2014.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Novel functional advanced echocardiography for the assessment of myocardial mechanics in children with neurocardiogenic syncope – a blinded prospective speckle tracking head-up tilt-table challenge study

Hensel

Roskopf

Schneyder

et al. 2018

BMC Cardiovasc Disord

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“…Body size (body mass index [BMI] and body surface area [BSA]) and physical activity level were similar in the two groups, not explaining the observed difference in cardiac volumes. No differences were seen in systolic or diastolic LV function or size (Table ), with previous studies presenting incongruous LVEDV in syncope subjects . Right and left ventricular function seem especially interlinked during hypovolemic stress, with reduced LV compliance (enhancing LV preload) when RV preload is reduced .…”

Section: Discussionmentioning

confidence: 52%

“…Echocardiographic findings in syncope have presented inconsistent results regarding heart dimensions and function, in part due to group differences regarding age, sex, and medication . No previous study has focused on echocardiographic findings in young women with VVS and healthy controls.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular biomarkers and echocardiographic findings at rest and during graded hypovolemic stress in women with recurrent vasovagal syncope

Lindenberger

Fedorowski

Melander

et al. 2019

Cardiovasc electrophysiol

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Introduction Vasovagal reflex is the most common type of syncope but its etiology is not fully elucidated. Venous return and cardiac output are key in hemodynamic control. The aim of the study was to assess cardiovascular biomarkers and echocardiographic measures at rest and during hypovolemia in women with and without a history of vasovagal syncope. Methods Fourteen women (aged 18‐30) suffering from recurrent vasovagal syncope and 15 age‐matched healthy women were included. Graded lower body negative pressure (LBNP) was used to create central hypovolemic stress until signs of presyncope occurred. Echocardiography was applied at rest and throughout LBNP. Cardiovascular biomarkers: copeptin, mid‐regional proadrenomedullin, mid‐regional pro‐ANP, C‐terminal proendothelin‐1, and plasma norepinephrine were measured both at rest and throughout graded hypovolemia to presyncope. Results Women prone to vasovagal syncope presented with a narrower right ventricle (RV) (29 ± 1 vs 32 ± 1 mm, P < .05), smaller left atrium (36 ± 2 vs 47 ± 3 cm3, P < .01) and lower cardiac output at rest (3.1 ± 0.2 vs 3.7 ± 0.2 L/min, P < .05) and during graded hypovolemia (P < .05). Copeptin was elevated at rest (4.3 ± 0.8 vs 2.5 ± 0.2 pmol/L, P < .05) and increased more in women with vasovagal syncope during progression of LBNP (P < .01). At rest, lower C‐terminal proendothelin‐1 (35 ± 5 vs 46 ± 2 pmol/L, P < .05) and higher norepinephrine levels (1.1 ± 0.1 vs 0.8 ± 0.1 nmol/L, P < .01) were seen in women with vasovagal syncope. Conclusion Women prone to vasovagal syncope demonstrate reduced cardiac preload, lower cardiac output, as well as increased release of vasopressin in rest and during hypovolemic challenge. The results emphasize the importance of venous return and cardiac output in the pathogenesis of vasovagal syncope.

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“…No current theory is without controversy, and none are fully accepted. 37,38 The prognosis for NMS syncope is generally good, and the mortality rate is low. 39,40 However, there are individuals in whom NMS episodes occur daily or several times weekly (''malignant'' NMS) and can dramatically alter quality of life and result in the inability to even work.…”

Section: Neurally Mediated Syncopementioning

confidence: 99%

Syncope

Ray

Kusumoto

Goldschlager

2014

J Intensive Care Med

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Syncope is common representing approximately 3% of ED visits and up to 6% of hospital admissions, with a cost close to 2 billion dollars per year. Diagnostic testing is often poorly sensitive and evaluations commonly lack a standardized approach. A mindful and systematic approach can increase sensitivity and improve diagnostic accuracy. A thorough history and physical exam is paramount, as conclusions drawn from the history and exam will guide further assessment. Developing a strategy for the first and, if necessary, subsequent tests will improve the accuracy of identifying the etiology of syncope and reduce cost. Although syncope has a favorable prognosis, identification of patients with structural heart disease is critical, as these patients are at greatest risk for mortality. Several risk scoring systems have been developed to help separate high risk from low risk patients.

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Effect of Head-Up Tilt-Table Testing on Left Ventricular Longitudinal Strain in Patients With Neurocardiogenic Syncope

Cited by 8 publications

References 24 publications

Novel functional advanced echocardiography for the assessment of myocardial mechanics in children with neurocardiogenic syncope – a blinded prospective speckle tracking head-up tilt-table challenge study

Novel functional advanced echocardiography for the assessment of myocardial mechanics in children with neurocardiogenic syncope – a blinded prospective speckle tracking head-up tilt-table challenge study

Cardiovascular biomarkers and echocardiographic findings at rest and during graded hypovolemic stress in women with recurrent vasovagal syncope

Syncope

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