TY - JOUR
T1 - Small left atrial volume is an independent predictor for fainting during head-up tilt test
T2 - The impact of intracardiac volume reserve in vasovagal syncope
AU - Moon, Jeonggeun
AU - Shim, Jaemin
AU - Park, Jae Hyung
AU - Hwang, Hye Jin
AU - Joung, Boyoung
AU - Ha, Jong Won
AU - Lee, Moon Hyoung
AU - Pak, Hui Nam
N1 - Funding Information:
The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology. This work was supported by a grant of the Korea Health 21 R&D Project ( A085136 ), Ministry of Health and Welfare , and Basic Science Research Program under the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology ( 2010-0010537 ), Republic of Korea. We also would like to thank the Research Affairs Department of Yonsei University College of Medicine for excellent assistance in statistical analysis.
PY - 2013/6/5
Y1 - 2013/6/5
N2 - Background: Vigorous left ventricular (LV) contraction with progressive ventricular emptying during orthostatic stress may induce hyper-responsiveness of cardiac mechanoreceptor and vasovagal syncope (VVS). We hypothesized that intracardiac volume reserve estimated by the left atrial (LA) volume index (LAVI) plays an important role in the mechanism of VVS. Methods: A total of 234 patients (115 male, 44 ± 18 years) who underwent head-up tilt test (HTT) and transthoracic echocardiography for unexplained syncope were consecutively enrolled. Patients with a positive HTT result (HTT+; n = 152) were compared with those with negative HTT response (HTT-; n = 82). Results: 1. Compared to HTT- patients, HTT+ patients were younger (41 ± 17 vs. 48 ± 17 years, p = 0.005), included a higher number of females (56% vs. 50%, p = 0.009) and showed higher basal heart rate (67 ± 12 vs. 63 ± 11 bpm, p = 0.047). 2. LAVI (20 ± 5 vs. 26 ± 13 ml/m2, p < 0.001), LV end-diastolic dimension (47.4 ± 3.7 vs. 49.0 ± 4.1 mm, p = 0.015), and the proportion of LV hypertrophy (13% vs. 24%, p = 0.027) were smaller and early diastolic mitral annulus velocity was higher (9.7 ± 3.0 vs. 8.5 ± 2.6 cm/s, p = 0.004) in HTT+ patients than those in HTT- group. 3. LAVI (OR 0.917 (0.860-0.977), p = 0.007) was the only independent predictor of HTT induced VVS, and LAVI had a linear correlation with time to syncope during HTT (r = 0.39, p = 0.034). In addition, patients with LAVI ≥ 36 ml/m2 did not faint during HTT. Conclusion: Small LA volume is an independent predictor of HTT-induced VVS. Limited intracardiac volume reserve might play an important role in the mechanism of VVS.
AB - Background: Vigorous left ventricular (LV) contraction with progressive ventricular emptying during orthostatic stress may induce hyper-responsiveness of cardiac mechanoreceptor and vasovagal syncope (VVS). We hypothesized that intracardiac volume reserve estimated by the left atrial (LA) volume index (LAVI) plays an important role in the mechanism of VVS. Methods: A total of 234 patients (115 male, 44 ± 18 years) who underwent head-up tilt test (HTT) and transthoracic echocardiography for unexplained syncope were consecutively enrolled. Patients with a positive HTT result (HTT+; n = 152) were compared with those with negative HTT response (HTT-; n = 82). Results: 1. Compared to HTT- patients, HTT+ patients were younger (41 ± 17 vs. 48 ± 17 years, p = 0.005), included a higher number of females (56% vs. 50%, p = 0.009) and showed higher basal heart rate (67 ± 12 vs. 63 ± 11 bpm, p = 0.047). 2. LAVI (20 ± 5 vs. 26 ± 13 ml/m2, p < 0.001), LV end-diastolic dimension (47.4 ± 3.7 vs. 49.0 ± 4.1 mm, p = 0.015), and the proportion of LV hypertrophy (13% vs. 24%, p = 0.027) were smaller and early diastolic mitral annulus velocity was higher (9.7 ± 3.0 vs. 8.5 ± 2.6 cm/s, p = 0.004) in HTT+ patients than those in HTT- group. 3. LAVI (OR 0.917 (0.860-0.977), p = 0.007) was the only independent predictor of HTT induced VVS, and LAVI had a linear correlation with time to syncope during HTT (r = 0.39, p = 0.034). In addition, patients with LAVI ≥ 36 ml/m2 did not faint during HTT. Conclusion: Small LA volume is an independent predictor of HTT-induced VVS. Limited intracardiac volume reserve might play an important role in the mechanism of VVS.
KW - Echocardiography
KW - Left atrium
KW - Tilt test
KW - Vasovagal syncope
UR - http://www.scopus.com/inward/record.url?scp=84877786350&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2011.09.076
DO - 10.1016/j.ijcard.2011.09.076
M3 - Article
C2 - 22000265
AN - SCOPUS:84877786350
VL - 166
SP - 44
EP - 49
JO - International Journal of Cardiology
JF - International Journal of Cardiology
SN - 0167-5273
IS - 1
ER -