ArticleJournal of the American Heart Association2019
Impact of Cardiovascular Neurohormones on Onset of Vasovagal Syncope Induced by Head-up Tilt.
Article in Journal of the American Heart Association, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 1 of them a synthesis that pooled it.
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Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it, 28 citations in OpenAlex.
- Cardioneuroablation for the treatment of reflex syncope and functional bradyarrhythmias: A Scientific Statement of the European Heart Rhythm Association (EHRA) of the ESC, the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS) and the Latin American Heart Rhythm Society (LAHRS).Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2024Guideline
- The Correlation and Predictive Value of Prognostic Nutrition Index with Vasovagal Syncope in Children.Pediatric cardiology · 2026Article
- Article
- Takotsubo Syndrome Associated with Neurally Mediated Reflex Syncope: A Meta-summary of Case Reports and Literature Review.Reviews in cardiovascular medicine · 2024Article
- Cardiovascular autonomic dysfunction in post-COVID-19 syndrome: a major health-care burden.Nature reviews. Cardiology · 2024Review
- Twenty-five years of research on syncope.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2023Article
- Predictive analysis of catecholamines and electrolytes for recurrence of orthostatic intolerance in children.Frontiers in pediatrics · 2023Article
- Article
- Association of polymorphisms in endothelin-1 and endothelin receptor a genes with vasovagal syncope.Physiological research · 2022Article
- Simultaneous beat-to-beat heart rate and systolic blood pressure variability in patients with and without neurally mediated syncope.Journal of cardiovascular and thoracic research · 2022Article
- Vasoactive Biomarkers in Patients With Vasovagal Syncope During Head-Up Tilt Test: A Case-Control Study.Clinical Medicine Insights. Cardiology · 2022Article
- Underlying hemodynamic differences are associated with responses to tilt testing.Scientific reports · 2021Article
- Neurohormones in the Pathophysiology of Vasovagal Syncope in Adults.Frontiers in cardiovascular medicine · 2020Review
- Timing of Circulatory and Neurological Events in Syncope.Frontiers in cardiovascular medicine · 2020Review
- Impact of Cardiovascular Neurohormones on Onset of Vasovagal Syncope Induced by Head-up Tilt.Journal of the American Heart Association · 2019Article
- Neurohormones in Vasovagal Syncope: Are They Important?Journal of the American Heart Association · 2019Article
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Authors and funding
7 authors at 4 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background Vasovagal reflex is the most common form of syncope, but the pathophysiological mechanisms that initiate the reflex are not well understood. We aimed to study supine and early orthostatic levels of the neurohormones involved in control of circulatory homeostasis in relation to the onset of tilt-induced vasovagal syncope (VVS). Methods and Results A total of 827 patients who were investigated for unexplained syncope with head-up tilt test (HUT) and optional nitroglycerin provocation (Italian protocol) had blood samples collected while supine and after 3-minutes of HUT. Of these, 173 (20.9%) patients developed VVS during drug-free HUT, 161 of whom (males 44.7%; age 45±21 years) had complete data. We analyzed levels of epinephrine, norepinephrine, C-terminal pro-arginine vasopressin, C-terminal endothelin-1, and midregional fragments of pro-atrial natriuretic peptide and pro-adrenomedullin in relation to time from tilt-up to onset of VVS. We applied a linear regression model adjusted for age and sex. The mean time to syncope was 11±7 minutes. Older age (β=0.13; SE=0.03, P<0.001), higher supine systolic blood pressure (β=0.06; SE=0.03, P=0.02), and higher supine midregional fragment of pro-adrenomedullin predicted longer time to syncope (β=2.31; SE=0.77, P=0.003), whereas supine levels of other neurohormones were not associated with time to syncope. Among 151 patients who developed VVS later than 3 minutes of HUT, increase in epinephrine (β=-3.24; SE=0.78, P<0.001) and C-terminal pro-arginine vasopressin (β=-2.07; SE=0.61, P=0.001) at 3 minutes of HUT were related to shorter time to syncope. Conclusions Older age, higher blood pressure, and higher level of pro-adrenomedullin are associated with later onset of VVS during tilt testing, whereas greater increase of tilt-induced epinephrine and vasopressin release correlate with shorter time to syncope.
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