title: Pulse wave analysis of the aortic pressure waveform in patients with vasovagal syncope.
abstract: Vascular reflex mechanisms contribute to vasovagal syncope. However, the alterations in central haemodynamics in patients with vasovagal syncope are unknown. 30 consecutive patients (36.5 ± 15 years, 14 females) with recurrent vasovagal syncope (VVS) and a positive tilt table test were compared to 39 age- and sex-matched controls (36.9 ± 16 years, 15 females) with a negative tilt table result and no history of syncope. Central aortic pressure parameters including augmentation index and central pulse pressure as markers of aortic stiffness were generated non-invasively by applanation tonometry of the radial artery and use of a validated mathematical transfer function. No difference in aortic augmentation index was observed between groups. (VVS 9 ± 2.6 vs. Control 11 ± 2.4, p = 0.8). However, in patients with vasovagal syncope the aortic pressure waveform significantly differed from healthy controls. A prolonged time to the peak of aortic pressure wave (aortic T2) was observed in patients with vasovagal syncope (226 ± 24 vs. 208 ± 21 ms, p = 0.001). Furthermore time to the first shoulder of the aortic pressure wave (aortic T1) was slightly shorter compared to healthy controls, but did not reach statistical significance (106 ± 22 vs. 110 ± 12 ms, p = 0.33). Patients with vasovagal syncope have an altered aortic pressure waveform at rest, but no signs of elevated aortic stiffness. The underlying mechanisms for these findings may potentially result from a complex imbalance of the autonomic nervous system with a continuous deregulation of the sympathetic and parasympathetic reflex arcs.
authors.affiliation: Department of Cardiovascular Surgery, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany. s.pecha@uke.de.
authors.forename: Simon
authors.initials: S
authors.lastname: Pecha
authors.affiliation: Department of Cardiovascular Surgery, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
authors.forename: Samer
authors.initials: S
authors.lastname: Hakmi
authors.affiliation: Department of Cardiology/Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
authors.forename: Iris
authors.initials: I
authors.lastname: Wilke
authors.affiliation: Department of Cardiovascular Surgery, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
authors.forename: Yalin
authors.initials: Y
authors.lastname: Yildirim
authors.affiliation: Department of Cardiology/Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
authors.forename: Boris
authors.initials: B
authors.lastname: Hoffmann
authors.affiliation: Department of Cardiovascular Surgery, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
authors.forename: Hermann
authors.initials: H
authors.lastname: Reichenspurner
authors.affiliation: Department of Cardiology/Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Willems
authors.affiliation: Department of Cardiology/Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
authors.forename: Yskert
authors.initials: Y
authors.lastname: von Kodolitsch
authors.affiliation: Department of Cardiology/Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
authors.forename: Ali
authors.initials: A
authors.lastname: Aydin
mesh_terms: D000328:Adult; D062186:Arterial Pressure; D001341:Autonomic Nervous System / Q000503:physiopathology*; D001794:Blood Pressure; D016022:Case-Control Studies; D004562:Electrocardiography; D005260:Female; D005858:Germany; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D063177:Pulse Wave Analysis; D019462:Syncope, Vasovagal / Q000503:physiopathology*; D018667:Tilt-Table Test; D055815:Young Adult
keywords: Applanation tonometry; Autonomic nervous system; Central aortic pressure; Pulse wave; Vasovagal syncope