The Role of the Baroreflex in Tilt Table Testing: Outcome and Type of Response

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• 作者：Ashish Chaddha ; MD ; Kevin E. Wenzke ; MD ; Michele Brignole ; MD ; Stephen L. Wasmund ; PhD ; Richard L. Page ; MD ; Mohamed H. Hamdan ; MD ; MBA ; ^{mhamdan@medicine.wisc.edu}
• 关键词：baroreflex gain ; tilt table testing ; vasovagal syncope
• 刊名：JACC: Clinical Electrophysiology
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：2
• 期：7
• 页码：812-817
• 全文大小：187 K
• 卷排序：2

文摘

The purpose of this study was to better understand the role of the baroreflex in tilt-induced vasovagal syncope (VVS).BackgroundThe role of the baroreflex in tilt-induced VVS remains controversial. The authors hypothesized that: 1) patients with positive tilt table test (TTT) results have greater baroreflex gain (BRG) compared with patients with negative TTT results; and 2) patients with tilt-induced asystole have greater BRG compared with patients without asystole.MethodsUsing the sequence method, BRG measurements were obtained in 438 consecutive patients undergoing TTT. Two hundred sixty-eight patients (61%) had positive TTT results (mean age 50 ± 21 years; 34% men), and 170 patients (39%) had negative TTT results (mean age 48 ± 21 years; 35% men).ResultsMean BRG was significantly higher in patients with positive TTT results compared with those with negative TTT results (12.9 ± 6.0 ms/mm Hg vs. 11.5 ± 6.0 ms/mm Hg; p = 0.01). Among the 268 patients with positive TTT results, 23 (9%) had more than 3 s of asystole (mean age 37 ± 17; 30% men), and 245 patients had a mixed vasodepressor or cardioinhibitory response without asystole (mean age 51 ± 17 years; 34% men). Mean BRG was greater in patients with tilt-induced asystole (>3 s) compared with patients without asystole (15.3 ± 5.9 ms/mm Hg vs. 12.7 ± 5.9 ms/mm Hg; p = 0.03).ConclusionsThe results of this study demonstrate that baseline BRG was higher in patients with positive TTT results compared with those with negative TTT results, with greater values noted in patients with tilt-induced asystole (>3 s) compared with those without asystole.