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The pathophysiologic mechanisms associated with hypotensive susceptibility

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Abstract

Introduction

Patients with vasovagal syncope (VVS) and positive tilt table test (TTT) were not found to benefit from pacing in the ISSUE-3 trial despite the presence of spontaneous asystole during monitoring. “Hypotensive susceptibility” unmasked by TTT was reported as a possible explanation. The purpose of this study was to assess the pathophysiologic mechanisms associated with hypotensive susceptibility.

Methods

366 consecutive patients with the diagnosis of VVS who also had TTT were identified. Baroreflex gain (BRG) in addition to blood pressure (BP) and heart rate (HR) responses during the first 20 min of TTT were analyzed and compared between patients with positive TTT (n = 275, 75 %) and negative TTT (n = 91, 25 %).

Results

The mean BRG was similar between the groups (12.5 ± 6.3 versus 12.4 ± 6.3 ms/mmHg, p = 0.72); however, an age-dependent decrease was noted (17.6 ± 4.8, 15.0 ± 6.0, 10.6 ± 4.2, 10.3 ± 6.4 and 9.9 ± 8.5 ms/mmHg for patients <21, 21–40, 41–60, 61–80 and >80 years old, respectively; p < 0.001). In addition, we saw a main effect of age on the type of response with a greater prevalence of a vasodepressor response in older subjects (p < 0.001). During the first 20 min of TTT, BP was similar in patients with tilt-positive VVS when compared with patients with tilt-negative VVS; however, HR was significantly lower.

Conclusion

BRG is similar in tilt-positive VVS patients when compared with tilt-negative VVS patients. An age-dependent decrease in BRG was noted with a higher prevalence of a vasodepressor response seen in older patients. The clinical significance of the blunted HR response in tilt-positive VVS remains to be determined.

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Abbreviations

BP:

Blood pressure

BRG:

Baroreflex gain

DBP:

Diastolic blood pressure

EF:

Ejection fraction

HR:

Heart rate

MBP:

Mean blood pressure

SBP:

Systolic blood pressure

TTT:

Tilt table test

VVS:

Vasovagal syncope

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Acknowledgments

This work was supported in part by funds provided from the Mildred and Marv Conney Chair in Cardiology.

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, School of Medicine and Public Health, University of Wisconsin, H4/534 Clinical Science Center, 600 Highland Avenue, Madison, WI, 53792-3248, USA

    Ashish Chaddha, Kevin E. Wenzke, Stephen L. Wasmund, Richard L. Page & Mohamed H. Hamdan

  2. Geriatric Cardiology and Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

    Martina Rafanelli

  3. Ospedali del Tigullio, Lavagna, Italy

    Michele Brignole

  4. National Heart and Lung Institute, Imperial College, London, UK

    Richard Sutton

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  1. Ashish Chaddha
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  2. Martina Rafanelli
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Correspondence to Mohamed H. Hamdan.

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Chaddha, A., Rafanelli, M., Brignole, M. et al. The pathophysiologic mechanisms associated with hypotensive susceptibility. Clin Auton Res 26, 261–268 (2016). https://doi.org/10.1007/s10286-016-0362-x

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