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Heart rate variability during head-up tilt test in patients with syncope of unknown origin.
Kardiol Pol. 2002 Nov; 57(11):399-406.KP

Abstract

BACKGROUND

Analysis of pathophysiological mechanisms responsible for vaso-vagal reaction reveals a close relationship between neurocardiogenic syncope and the preceding abnormalities of autonomic nervous system (ANS). Therefore, the interest in the assessment of heart rate variability (HRV) for detecting and establishing therapy in patients with syncope due to vaso-vagal mechanism is not surprising.

AIM

To assess ANS changes during tilt testing in patients with syncope of unknown origin.

METHODS

Forty patients (18 males, mean age 34.8+/-15.8 years) with a history of at least two syncopal episodes during the last 6 months and 24 healthy controls underwent tilt testing. Spectral HRV analysis was performed from ECG recorded 5 min before tilting (period A), 5 min after tilting (period B), and 5 min before syncope (or 20-25 min of tilt test when syncope did not occur) (period C).

RESULTS

Tilt test was positive in 23 (58%) patients; 12 (30%) had mixed response, 10 (25%) - vasodepressive, and 1 (3%) - cardioinhibitory reaction. The mean time from tilt to syncope was 22.3 minutes. One (4%) control subject developed syncope. In all groups a decrease of LF and HF power, as well as an increase in the LF/HF ratio in response to tilting were observed. The LF/HF values were significantly different between patients with mixed vaso-vagal reaction and controls (1.9 vs 4.2; p=0.04). In the C-B periods the highest decrease in the HF spectra was found in patients with mixed reaction and was significantly greater than in other patients or controls. Also, patients with mixed reaction had the highest increase in LF values which was significantly more pronounced than in patients with vasodepressive reaction (10139.3 vs 466.9; p=0.003). As a result, the change in LF/HF ratio was positive in patients with mixed reaction, controls and patients with negative result of tilt test, and negative - in patients with vaso-depressive syncope, reaching statistical significance between patients with mixed and vaso-depressive response (2.04 vs -0.51; p=0.03).

CONCLUSIONS

The pattern of HRV changes during tilt testing depends on the type of vaso-vagal reaction which leads to syncope. The most accurate HRV parameter for identification of patients with reflex syncope is the LF/HF ratio.

Authors+Show Affiliations

Department of Internal Medicine and Cardiology, Central Military Hospital, Medical Academy, Warsaw, Poland.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng pol

PubMed ID

12961000

Citation

Gielerak, Grzegorz, et al. "Heart Rate Variability During Head-up Tilt Test in Patients With Syncope of Unknown Origin." Kardiologia Polska, vol. 57, no. 11, 2002, pp. 399-406.
Gielerak G, Makowski K, Kramarz E, et al. Heart rate variability during head-up tilt test in patients with syncope of unknown origin. Kardiol Pol. 2002;57(11):399-406.
Gielerak, G., Makowski, K., Kramarz, E., Cholewa, M., Dłuzniewska, E., Roszczyk, A., & Bogaj, A. (2002). Heart rate variability during head-up tilt test in patients with syncope of unknown origin. Kardiologia Polska, 57(11), 399-406.
Gielerak G, et al. Heart Rate Variability During Head-up Tilt Test in Patients With Syncope of Unknown Origin. Kardiol Pol. 2002;57(11):399-406. PubMed PMID: 12961000.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Heart rate variability during head-up tilt test in patients with syncope of unknown origin. AU - Gielerak,Grzegorz, AU - Makowski,Karol, AU - Kramarz,Elzbieta, AU - Cholewa,Marian, AU - Dłuzniewska,Ewa, AU - Roszczyk,Anna, AU - Bogaj,Agnieszka, PY - 2003/9/10/pubmed PY - 2003/9/10/medline PY - 2003/9/10/entrez SP - 399 EP - 406 JF - Kardiologia polska JO - Kardiol Pol VL - 57 IS - 11 N2 - BACKGROUND: Analysis of pathophysiological mechanisms responsible for vaso-vagal reaction reveals a close relationship between neurocardiogenic syncope and the preceding abnormalities of autonomic nervous system (ANS). Therefore, the interest in the assessment of heart rate variability (HRV) for detecting and establishing therapy in patients with syncope due to vaso-vagal mechanism is not surprising. AIM: To assess ANS changes during tilt testing in patients with syncope of unknown origin. METHODS: Forty patients (18 males, mean age 34.8+/-15.8 years) with a history of at least two syncopal episodes during the last 6 months and 24 healthy controls underwent tilt testing. Spectral HRV analysis was performed from ECG recorded 5 min before tilting (period A), 5 min after tilting (period B), and 5 min before syncope (or 20-25 min of tilt test when syncope did not occur) (period C). RESULTS: Tilt test was positive in 23 (58%) patients; 12 (30%) had mixed response, 10 (25%) - vasodepressive, and 1 (3%) - cardioinhibitory reaction. The mean time from tilt to syncope was 22.3 minutes. One (4%) control subject developed syncope. In all groups a decrease of LF and HF power, as well as an increase in the LF/HF ratio in response to tilting were observed. The LF/HF values were significantly different between patients with mixed vaso-vagal reaction and controls (1.9 vs 4.2; p=0.04). In the C-B periods the highest decrease in the HF spectra was found in patients with mixed reaction and was significantly greater than in other patients or controls. Also, patients with mixed reaction had the highest increase in LF values which was significantly more pronounced than in patients with vasodepressive reaction (10139.3 vs 466.9; p=0.003). As a result, the change in LF/HF ratio was positive in patients with mixed reaction, controls and patients with negative result of tilt test, and negative - in patients with vaso-depressive syncope, reaching statistical significance between patients with mixed and vaso-depressive response (2.04 vs -0.51; p=0.03). CONCLUSIONS: The pattern of HRV changes during tilt testing depends on the type of vaso-vagal reaction which leads to syncope. The most accurate HRV parameter for identification of patients with reflex syncope is the LF/HF ratio. SN - 0022-9032 UR - https://www.unboundmedicine.com/medline/citation/12961000/Heart_rate_variability_during_head_up_tilt_test_in_patients_with_syncope_of_unknown_origin_ L2 - https://antibodies.cancer.gov/detail/CPTC-GZMA-1 DB - PRIME DP - Unbound Medicine ER -
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