Small left atrial volume is an independent predictor for fainting during head-up tilt test

The impact of intracardiac volume reserve in vasovagal syncope

Jeonggeun Moon, Jaemin Shim, Jae Hyung Park, Hye Jin Hwang, Boyoung Joung, Jong Won Ha, Moon Hyoung Lee, Hui Nam Pak

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)44-49
Number of pages6
JournalInternational Journal of Cardiology
Volume166
Issue number1
DOIs
Publication statusPublished - 2013 Jun 5
Externally publishedYes

Fingerprint

Vasovagal Syncope
Syncope
Head
Mechanoreceptors
Left Ventricular Hypertrophy
Echocardiography

Keywords

  • Echocardiography
  • Left atrium
  • Tilt test
  • Vasovagal syncope

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Small left atrial volume is an independent predictor for fainting during head-up tilt test : The impact of intracardiac volume reserve in vasovagal syncope. / Moon, Jeonggeun; Shim, Jaemin; Park, Jae Hyung; Hwang, Hye Jin; Joung, Boyoung; Ha, Jong Won; Lee, Moon Hyoung; Pak, Hui Nam.

In: International Journal of Cardiology, Vol. 166, No. 1, 05.06.2013, p. 44-49.

Research output: Contribution to journalArticle

Moon, Jeonggeun ; Shim, Jaemin ; Park, Jae Hyung ; Hwang, Hye Jin ; Joung, Boyoung ; Ha, Jong Won ; Lee, Moon Hyoung ; Pak, Hui Nam. / Small left atrial volume is an independent predictor for fainting during head-up tilt test : The impact of intracardiac volume reserve in vasovagal syncope. In: International Journal of Cardiology. 2013 ; Vol. 166, No. 1. pp. 44-49.
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abstract = "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.",
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T2 - The impact of intracardiac volume reserve in vasovagal syncope

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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

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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.

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KW - Echocardiography

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