title: Jugular venous reflux and plasma endothelin-1 are associated with cough syncope: a case control pilot study.
abstract: BACKGROUND
  Jugular venous reflux (JVR) has been reported to cause cough syncope via retrograde-transmitted venous hypertension and consequently decreased cerebral blood flow (CBF). Unmatched frequencies of JVR and cough syncope led us to postulate that there should be additional factors combined with JVR to exaggerate CBF decrement during cough, leading to syncope. The present pilot study tested the hypothesis that JVR, in addition to an increased level of plasma endothelin-1 (ET-1), a potent vasoconstrictor, is involved in the pathophysiology of cough syncope.
  
  
  METHODS
  Seventeen patients with cough syncope or pre-syncope (Mean[SD] = 74.63(12.37) years; 15 males) and 51 age/gender-matched controls received color-coded duplex ultrasonography for JVR determination and plasma ET-1 level measurements.
  
  
  RESULTS
  Multivariate logistic analysis showed that the presence of both-side JVR (odds ratio [OR] = 10.77, 95% confident interval [CI] = 2.40-48.35, p = 0.0019) and plasma ET-1 > 3.43 pg/ml (OR = 14.57, 95% CI = 2.95-71.59, p = 0.001) were independently associated with the presence of cough syncope/ pre-syncope respectively. There was less incidence of cough syncope/ pre-syncope in subjects with the absence of both-side JVR and a plasma ET-1 ≦3.43 pg/ml. Presence of both side JVR and plasma ET-1 level of > 3.43 pg/ml, increased risk for cough syncope/pre-syncope (p < 0.001).
  
  
  CONCLUSIONS
  JVR and higher plasma levels of ET-1 are associated with cough syncope/ pre-syncope. Although sample size of this study was small, we showed a synergistic effect between JVR and plasma ET-1 levels on the occurrence of cough syncope/pre-syncope. Future studies should confirm our pilot findings.
authors: Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan.
authors: Chih-Ping
authors: CP
authors: Chung
authors: Chun-Yu
authors: CY
authors: Cheng
authors: Robert
authors: R
authors: Zivadinov
authors: Wei-Chih
authors: WC
authors: Chen
authors: Wen-Yung
authors: WY
authors: Sheng
authors: Yu-Chin
authors: YC
authors: Lee
authors: Han-Hwa
authors: HH
authors: Hu
authors: Hung-Yi
authors: HY
authors: Hsu
authors: Kuang-Yao
authors: KY
authors: Yang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D062186:Arterial Pressure / Q000502:physiology; D016022:Case-Control Studies; D002560:Cerebrovascular Circulation / Q000502:physiology*; D003371:Cough / Q000150:complications; D018618:Echocardiography, Doppler, Color; D004562:Electrocardiography; D004569:Electroencephalography; D019332:Endothelin-1 / Q000097:blood*; D005260:Female; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D013223:Statistics as Topic; D013575:Syncope / Q000097:blood* / Q000209:etiology
chemical_list: D019332:Endothelin-1