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Monitoring of cerebral oximetry during head-up tilt test in adults with history of syncope and orthostatic intolerance.
Europace. 2018 09 01; 20(9):1535-1542.E

Abstract

Aims

We applied near-infrared-spectroscopy (NIRS) to measure absolute frontal cerebral tissue oxygen saturation (SctO2) during head-up tilt test (HUT) in patients investigated for unexplained syncope.

Methods and results

Synchronized non-invasive beat-to-beat haemodynamic monitoring, ECG, SctO2 (NIRS; normal range: 60-80%), and peripheral oxygen saturation (left hand, SpO2) were applied during HUT in a random sample of patients with unexplained syncope. Tracings of 54 patients (mean-age: 55 ± 19 years, 39% male) with negative HUT, vasovagal syncope (VVS), or orthostatic hypotension (OH) were analysed. In 44 patients HUT was diagnostic, in 10 HUT was negative. Thirty-one experienced VVS. Of these, 6 had spontaneous and 25 nitroglycerin-induced syncope. Thirteen patients had orthostatic hypotension (OH). Although there was no significant change in mean-arterial pressure from baseline to 1 min before syncope or end of passive HUT phase (-1.4 ± 13.9 mmHg; P = 0.45), there was a significant fall in SctO2 during the same period (-3.2 ± 3.2%; P ≤ 0.001). Among patients who experienced syncope, a decrease in SctO2 from 71 ± 5% at baseline to 53 ± 9% (P < 0.001) at syncope was observed. During HUT, there was a significant difference in delta SctO2 between spontaneous VVS (-4.5 ± 3.0%) and negative HUT (-1.3 ± 1.9%; P = 0.021), but not between spontaneous VVS and OH (-5.4 ± 4.2%; P = 0.65). In spontaneous VVS, progressive decrease of SctO2 was independent of mean arterial pressure decrease (P = 0.22).

Conclusions

Progressive decrease in cerebral tissue oxygenation independent of mean-arterial pressure may precede spontaneous vasovagal reflex during tilt. Patients experience syncope when SctO2 falls below 60%. These data confirm clinical utility of absolute cerebral oximetry monitoring for syncope investigation. We applied NIRS to measure frontal cerebral tissue oxygen saturation (SctO2) during head-up tilt test (HUT) in patients with unexplained syncope. In 44 of 54 patients, HUT was diagnostic. In patients with syncope, a significant SctO2-decrease was observed. Different patterns of SctO2 can be detected.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Bachus E
Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden. Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden.
Holm H
Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden. Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden.
Hamrefors V
Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden. Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden. Department of Medical Imaging and Physiology, Skåne University Hospital, Malmö, Sweden.
Melander O
Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden. Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden.
Sutton R
National Heart & Lung Institute, Imperial College, London, UK.
Magnusson M
Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden. Department of Cardiology, Inga Marie Nilssons gata 46, Skåne University Hospital, 205 02 Malmö, Sweden.
Fedorowski A
Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden. Department of Cardiology, Inga Marie Nilssons gata 46, Skåne University Hospital, 205 02 Malmö, Sweden.

MeSH

AdultAgedArterial PressureCerebrovascular CirculationFemaleFrontal LobeHumansHypotension, OrthostaticMaleMiddle AgedNitroglycerinOrthostatic IntoleranceOximetrySpectroscopy, Near-InfraredSyncopeSyncope, VasovagalTilt-Table TestVasodilator Agents

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29036615

Citation

Bachus, E, et al. "Monitoring of Cerebral Oximetry During Head-up Tilt Test in Adults With History of Syncope and Orthostatic Intolerance." Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups On Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology, vol. 20, no. 9, 2018, pp. 1535-1542.
Bachus E, Holm H, Hamrefors V, et al. Monitoring of cerebral oximetry during head-up tilt test in adults with history of syncope and orthostatic intolerance. Europace. 2018;20(9):1535-1542.
Bachus, E., Holm, H., Hamrefors, V., Melander, O., Sutton, R., Magnusson, M., & Fedorowski, A. (2018). Monitoring of cerebral oximetry during head-up tilt test in adults with history of syncope and orthostatic intolerance. Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups On Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology, 20(9), 1535-1542. https://doi.org/10.1093/europace/eux298
Bachus E, et al. Monitoring of Cerebral Oximetry During Head-up Tilt Test in Adults With History of Syncope and Orthostatic Intolerance. Europace. 2018 09 1;20(9):1535-1542. PubMed PMID: 29036615.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Monitoring of cerebral oximetry during head-up tilt test in adults with history of syncope and orthostatic intolerance. AU - Bachus,E, AU - Holm,H, AU - Hamrefors,V, AU - Melander,O, AU - Sutton,R, AU - Magnusson,M, AU - Fedorowski,A, PY - 2017/01/07/received PY - 2017/08/31/accepted PY - 2017/10/17/pubmed PY - 2019/4/23/medline PY - 2017/10/17/entrez SP - 1535 EP - 1542 JF - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology JO - Europace VL - 20 IS - 9 N2 - Aims: We applied near-infrared-spectroscopy (NIRS) to measure absolute frontal cerebral tissue oxygen saturation (SctO2) during head-up tilt test (HUT) in patients investigated for unexplained syncope. Methods and results: Synchronized non-invasive beat-to-beat haemodynamic monitoring, ECG, SctO2 (NIRS; normal range: 60-80%), and peripheral oxygen saturation (left hand, SpO2) were applied during HUT in a random sample of patients with unexplained syncope. Tracings of 54 patients (mean-age: 55 ± 19 years, 39% male) with negative HUT, vasovagal syncope (VVS), or orthostatic hypotension (OH) were analysed. In 44 patients HUT was diagnostic, in 10 HUT was negative. Thirty-one experienced VVS. Of these, 6 had spontaneous and 25 nitroglycerin-induced syncope. Thirteen patients had orthostatic hypotension (OH). Although there was no significant change in mean-arterial pressure from baseline to 1 min before syncope or end of passive HUT phase (-1.4 ± 13.9 mmHg; P = 0.45), there was a significant fall in SctO2 during the same period (-3.2 ± 3.2%; P ≤ 0.001). Among patients who experienced syncope, a decrease in SctO2 from 71 ± 5% at baseline to 53 ± 9% (P < 0.001) at syncope was observed. During HUT, there was a significant difference in delta SctO2 between spontaneous VVS (-4.5 ± 3.0%) and negative HUT (-1.3 ± 1.9%; P = 0.021), but not between spontaneous VVS and OH (-5.4 ± 4.2%; P = 0.65). In spontaneous VVS, progressive decrease of SctO2 was independent of mean arterial pressure decrease (P = 0.22). Conclusions: Progressive decrease in cerebral tissue oxygenation independent of mean-arterial pressure may precede spontaneous vasovagal reflex during tilt. Patients experience syncope when SctO2 falls below 60%. These data confirm clinical utility of absolute cerebral oximetry monitoring for syncope investigation. We applied NIRS to measure frontal cerebral tissue oxygen saturation (SctO2) during head-up tilt test (HUT) in patients with unexplained syncope. In 44 of 54 patients, HUT was diagnostic. In patients with syncope, a significant SctO2-decrease was observed. Different patterns of SctO2 can be detected. SN - 1532-2092 UR - https://www.unboundmedicine.com/medline/citation/29036615/Monitoring_of_cerebral_oximetry_during_head_up_tilt_test_in_adults_with_history_of_syncope_and_orthostatic_intolerance_ DB - PRIME DP - Unbound Medicine ER -