Is There A Structural Basis For Vasovagal Syncope? Cardiac Functions In Patients With Vasovagal Syncope

Öz

Aim: The pathophysiology of vasovagal syncope (VVS) is not completely understood. Some echocardiographic parameters have been defined to contribute to its pathophysiology. However. whether right atrial (RA) and right ventricular (RV) functions have any impact on development of VVS is not well known. In this study we aimed to evaluate the baseline echocardiographic parameters in patients with VVS with special focus on right ventricle and atrium functions. Material and methods: We evaluated the medical records of 42 patients with VVS and 41 age and sex matched healthy subjects. Patients with at least two syncopal attack and positive head-up-tilt test were enrolled in the study. All medical records of echocardiography and head-up-tilt test were obtained. Results: Among left ventricular function parameters, there were no significant difference between the groups. Right ventricle myocardial performance index (p= 0.003) and maximal pulmoner systolic flow velocity (PVmax) (p=0.03) were significantly differ between the groups. RAA was significantly larger (p=0.04) and the ratio of tricuspid filling velocities (E/A), (p=0.01) was significantly lower in VVS group. Conclusions: The findings of the present study indicate a subtle right atrial diastolic dysfunction in patients with VVS. Decreased right atrial contribution to RV filling may cause a lower RV stroke volüme which explains the lower PVmax values in our VVS group. All together, those findings may serve for a tendency to low output states and hypotension as in VVS.

Anahtar Kelimeler

• vasovagal syncope
• right ventricle
• right atrium
• PVmax

Vazovagal Senkopun Yapısal Bir Temeli Var mı? Vazovagal Senkoplu Hastalarda Kardiyak Fonksiyonlar

Öz

Amaç: Vazovagal senkopun (VVS) patofizyolojisi tam olarak anlaşılamamıştır. Patofizyolojisine katkıda bulunmak için bazı ekokardiyografik parametreler tanımlanmıştır. Fakat. sağ atriyal (RA) ve sağ ventrikül (RV) fonksiyonlarının vazovagal senkop gelişimi üzerinde herhangi bir etkisinin olup olmadığı iyi bilinmemektedir. Bu çalışmada, özellikle sağ ventrikül ve atriyum fonksiyonlarına odaklanarak VVS’li hastalarda temel ekokardiyografik parametreleri değerlendirmeyi amaçladık. Materyal ve metot: Vazovagal senkoplu 42 hasta ile yaş ve cinsiyet olarak eşleştirilmiş 41 sağlıklı kişinin tıbbi kayıtlarını inceledik. En az iki senkop atağı olan ve eğik masa testi pozitif olan hastalar çalışmaya alındı. Ekokardiyografi ve eğik masa testinin tüm tıbbi kayıtları elde edildi. Bulgular: Sol ventrikül ölçümleri açısından gruplar arasında anlamlı fark yoktu. Sağ ventrikül miyokardiyal performans indeksi (p= 0.003) ve maksimal pulmoner sistolik akım hızı (PVmax) (p=0.03) gruplar arasında anlamlı farklılık gösterdi. Vazosvagal senkop grubunda RA alanı anlamlı olarak daha büyüktü (p=0.04) ve triküspit doluş hızları (Et/At), (p=0.01) oranı anlamlı olarak daha düşüktü. Sonuç: Bu çalışmanın bulguları, VVS'li hastalarda hafif bir RV diyastolik işlev bozukluğuna işaret etmektedir. RV dolumuna sağ atriyal katkının azalması, daha düşük RV atım hacmine neden olabilir, bu da VVS grubumuzdaki daha düşük Pwmax değerlerini açıklayabilir. Hep birlikte değerlendirildiğinde, bu bulgular VVS'de olduğu gibi düşük kalp debisine ve hipotansiyona eğilime neden olabilir.

Anahtar Kelimeler

• Vazovagal senkop
• sağ atrium
• sağ ventrikül
• PVmax

Kaynakça

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