Genetic markers of vasovagal syncope

Sheldon, Robert S.; Gerull, Brenda

doi:10.1016/j.autneu.2021.102871

Cited by 7 publications

(3 citation statements)

References 59 publications

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“…In patients the initiation of treatment with the serotonin reuptake inhibitor sertraline 21 , has been linked to clinically worsening syncope in patients with vasovagal syncope. Interestingly, a kindred candidate gene analysis 17,22 implicated alleles of the serotonin reuptake transporter and of the 5HT1A receptor in the vasovagal phenotype. Acute intravenous infusions of clomipramine, a serotonin-speci c reuptake inhibitor, potentiates the provocation of the vasovagal re ex on tilt testing of patients with syncope [23][24][25][26] .…”

Section: Discussionmentioning

confidence: 99%

Serotonin reuptake inhibition for the prevention of vasovagal syncope: a systematic review and meta-analysis

Raj,

Lei,

Flevaris

et al. 2023

Clin Auton Res

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Purpose: Vasovagal syncope is a common clinical condition that lacks effective medical therapies despite being associated with signi cant morbidity. Current guidelines suggest that serotonin-speci c reuptake inhibitors, might suppress vasovagal syncope but supporting studies have been small and heterogenous. The purpose was to evaluate the e cacy of serotonin-speci c reuptake inhibitors to prevent syncope in patients with recurrent vasovagal syncope by conducting a systematic review and meta-analysis of published studies.Methods: Relevant randomized controlled trials were identi ed from the MEDLINE and Embase databases without language restriction from inception to August 2022, and clinicaltrials.gov. All studies were conducted in clinical syncope populations and compared the bene t of serotonin versus placebo. Weighted relative risks were estimated using random effects meta-analysis techniques.Results: Three studies (n=204) met inclusion criteria. Patients were 42±13 years of age and 51% female.Serotonin-speci c reuptake inhibitors were found to substantially reduce the likelihood of a patient having at least one recurrence of vasovagal syncope (relative risk [RR]=0.34 (0.20-0.60), p<0.01) with minimal between-study heterogeneity (I 2 =0%, p = 0.67). Serotonin-speci c reuptake inhibitors in two reports provided signi cant protection against clinical presyncope (RR = 0.43 (0.24-0.77, p <0.01), with minimal between-study heterogeneity (I 2 = 0%, p = 0.80).Conclusions: Serotonin-speci c reuptake inhibitors may be effective in preventing syncope induced by head-up-tilt testing and in syncope in the community in randomized, double-blinded clinical trials.

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Section: Discussionmentioning

confidence: 99%

Serotonin reuptake inhibition for the prevention of vasovagal syncope: a systematic review and meta-analysis

Raj,

Lei,

Flevaris

et al. 2023

Clin Auton Res

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“…Although the mechanisms underlying VVS are not completely clear, there is no doubt that its development is influenced by many factors, among which hereditary predisposition holds an important position [ 3 , 4 , 5 ]. Identification of VVS-associated genetic factors can expand the understanding of the molecular basis of its pathogenesis, and thus contribute to the development of new prevention and treatment strategies.…”

Section: Introductionmentioning

confidence: 99%

“…Consequently, genes that encode receptors, carrier proteins, and enzymes involved in the synthesis of neurotransmitters and vasoactive molecules were considered as possible VVS susceptibility loci. However, at the moment, data on the role of individual candidate genes in VVS are very inconsistent [ 3 , 4 , 5 ], which may be due to the small sample sizes, variations in criteria for VVS diagnosis, and insufficiently rigorous selection of control groups; these problems certainly need to be addressed.…”

Section: Introductionmentioning

confidence: 99%

Vasovagal Syncope Is Associated with Variants in Genes Involved in Neurohumoral Signaling Pathways

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Матвеева

Кулакова

et al. 2022

Genes

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Vasovagal syncope (VVS) is the most common cause of sudden loss of consciousness. VVS results from cerebral hypoperfusion, due to abnormal autonomic control of blood circulation, leading to arterial hypotension. It is a complex disease, and its development is largely associated with genetic susceptibility. Since abnormal neurohumoral regulation plays an important role in VVS development, we analyzed the association of VVS with polymorphic variants of ADRA1A , ADRB1 , HTR1A , ADORA2A , COMT , and NOS3 genes, the products of which are involved in neurohumoral signaling, in patients with a confirmed VVS diagnosis (157 subjects) and individuals without a history of syncope (161 subjects). We were able to identify the associations between VVS and alleles/genotypes ADRA1A rs1048101, ADRB1 rs1801253, ADORA2A rs5751876, and COMT rs4680, as well as NOS3 rs2070744 in biallelic combination with COMT rs4680. Thus, we are the first to observe, within a single study, the role of the genes that encode α- and β-adrenergic receptors, catechol-O-methyltransferase, adenosine receptors and nitric oxide synthase in VVS development. These findings demonstrate that the genes involved in neurohumoral signaling pathways contribute to the formation of a genetic susceptibility to VVS.

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