gms | German Medical Science

The aim of the study was the investigation of usefulness of typical vasovagal anamnesis, the analysis of heart rate variability (HRV) and noninvasive haemodynamical parameters in tilting patients with recurrent syncope.

Method: 170 patients were enrolled to research (41% male, mean age 50.5+/-17.9 yrs.) with history of recurrent syncope. The control group composed 19 healthy volunteers. Pts. were divided into following groups according to HUTT outcome: positive HUTT (the I. group) N=129; mean age 50.6 +/-17.8 yrs, 0.37 males; and negative HUTT (the II. group) N=41; mean age 50.0+/-18.3 yrs, 0.56 males. In all the initial anamnesis with the specific data of syncope, HUTT in Westminster protocol prolonged by nitroglycerin provocation, Holter ECG with HRV analysis, noninvasive haemodynamical estimation of heart rate and blood pressure were performed. Logistic regression was used in multivariate approach to identify the most predictive parameter of positive HUTT.

Results: HUTT explained origin of syncope in 129 patients (76%) of study group. In the I. group noted significant more (p<0.05): number of syncope, the prodromal symptoms and typical vasovagal anamnesis (p<0.00000) in comparison to the II. group. Noninvasive analysis of blood pressure (RR) during the HUTT showed higher value of RR in patients with negative outcome of HUTT in comparison to the others groups. During the HUTT significant lower heart rate was noted in patients with cardiodepressive reaction VASIS 2 than in patients with vasodepressive reaction VASIS 3. There were no differences in noninvasive haemodynamic analysis between control group and the I. group. In the II. group HRV parameters of spectral analysis during HUTT were significant lower in comparison to the I. and control group. Among multifactors analysis the highest sensitivity to positive HUTT had the presence of typical vasovagal anamnesis (OR 5.85, 95%CI, 2.72 – 12.56, p<0.00001).

Conclusions: The most useful parameter in prognosis of positive result of HUTT was typical anamnesis. Differences in HRV and noninvasive haemodynamical parameters in patients with syncope could evidence the disturbances in autonomic system.