Underlying hemodynamic differences are associated with responses to tilt testing

Abstract Aim of this study was to explore whether differences in resting hemodynamic parameters may be associated with tilt test results in unexplained syncope. We analyzed age, gender, systolic (SBP), diastolic blood pressure (DBP) and heart rate (HR) by merging three large databases of patients co...

Full description

Bibliographic Details
Main Authors: Artur Fedorowski, Giulia Rivasi, Parisa Torabi, Madeleine Johansson, Martina Rafanelli, Irene Marozzi, Alice Ceccofiglio, Niccolò Casini, Viktor Hamrefors, Andrea Ungar, Brian Olshansky, Richard Sutton, Michele Brignole, Gianfranco Parati
Format: Article
Language:English
Published: Nature Publishing Group 2021-09-01
Series:Scientific Reports
Online Access:https://doi.org/10.1038/s41598-021-97503-0
id doaj-fa061eb26f0342b8b1dedd70656c24f5
record_format Article
spelling doaj-fa061eb26f0342b8b1dedd70656c24f52021-09-12T11:24:27ZengNature Publishing GroupScientific Reports2045-23222021-09-011111610.1038/s41598-021-97503-0Underlying hemodynamic differences are associated with responses to tilt testingArtur Fedorowski0Giulia Rivasi1Parisa Torabi2Madeleine Johansson3Martina Rafanelli4Irene Marozzi5Alice Ceccofiglio6Niccolò Casini7Viktor Hamrefors8Andrea Ungar9Brian Olshansky10Richard Sutton11Michele Brignole12Gianfranco Parati13Department of Clinical Sciences, Lund UniversitySyncope Unit, Division of Geriatrics and Intensive Care Unit, Careggi Hospital, University of FlorenceDepartment of Clinical Sciences, Lund UniversityDepartment of Clinical Sciences, Lund UniversitySyncope Unit, Division of Geriatrics and Intensive Care Unit, Careggi Hospital, University of FlorenceSyncope Unit, Division of Geriatrics and Intensive Care Unit, Careggi Hospital, University of FlorenceSyncope Unit, Division of Geriatrics and Intensive Care Unit, Careggi Hospital, University of FlorenceSyncope Unit, Division of Geriatrics and Intensive Care Unit, Careggi Hospital, University of FlorenceDepartment of Clinical Sciences, Lund UniversitySyncope Unit, Division of Geriatrics and Intensive Care Unit, Careggi Hospital, University of FlorenceDivision of Cardiology, Department of Internal Medicine, University of Iowa HospitalsDepartment of Cardiology, Skåne University HospitalFaint & Fall Programme, IRCCS Istituto Auxologico Italiano, Ospedale San LucaFaint & Fall Programme, IRCCS Istituto Auxologico Italiano, Ospedale San LucaAbstract Aim of this study was to explore whether differences in resting hemodynamic parameters may be associated with tilt test results in unexplained syncope. We analyzed age, gender, systolic (SBP), diastolic blood pressure (DBP) and heart rate (HR) by merging three large databases of patients considered likely to be of vasovagal reflex etiology, comparing patients who had tilt-induced reflex response with those who did not. Tilt-induced reflex response was defined as spontaneous symptom reproduction with characteristic hypotension and bradycardia. Relationship of demographics and baseline supine BP to tilt-test were assessed using logistic regression models. Individual records of 5236 patients (45% males; mean age: 60 ± 22 years; 32% prescribed antihypertensive therapy) were analyzed. Tilt-positive (n = 3129, 60%) vs tilt-negative patients had lower SBP (127.2 ± 17.9 vs 129.7 ± 18.0 mmHg, p < 0.001), DBP (76.2 ± 11.5 vs 77.7 ± 11.7 mmHg, p < 0.001) and HR (68.0 ± 11.5 vs 70.5 ± 12.5 bpm, p < 0.001). In multivariable analyses, tilt-test positivity was independently associated with younger age (Odds ratio (OR) per 10 years:1.04; 95% confidence interval (CI), 1.01–1.07, p = 0.014), SBP ≤ 128 mmHg (OR:1.27; 95%CI, 1.11–1.44, p < 0.001), HR ≤ 69 bpm (OR:1.32; 95%CI, 1.17–1.50, p < 0.001), and absence of hypertension (OR:1.58; 95%CI, 1.38–1.81, p < 0.001). In conclusion, among patients with suspected reflex syncope, younger age, lower blood pressure and lower heart rate are associated with positive tilt-test result.https://doi.org/10.1038/s41598-021-97503-0
collection DOAJ
language English
format Article
sources DOAJ
author Artur Fedorowski
Giulia Rivasi
Parisa Torabi
Madeleine Johansson
Martina Rafanelli
Irene Marozzi
Alice Ceccofiglio
Niccolò Casini
Viktor Hamrefors
Andrea Ungar
Brian Olshansky
Richard Sutton
Michele Brignole
Gianfranco Parati
spellingShingle Artur Fedorowski
Giulia Rivasi
Parisa Torabi
Madeleine Johansson
Martina Rafanelli
Irene Marozzi
Alice Ceccofiglio
Niccolò Casini
Viktor Hamrefors
Andrea Ungar
Brian Olshansky
Richard Sutton
Michele Brignole
Gianfranco Parati
Underlying hemodynamic differences are associated with responses to tilt testing
Scientific Reports
author_facet Artur Fedorowski
Giulia Rivasi
Parisa Torabi
Madeleine Johansson
Martina Rafanelli
Irene Marozzi
Alice Ceccofiglio
Niccolò Casini
Viktor Hamrefors
Andrea Ungar
Brian Olshansky
Richard Sutton
Michele Brignole
Gianfranco Parati
author_sort Artur Fedorowski
title Underlying hemodynamic differences are associated with responses to tilt testing
title_short Underlying hemodynamic differences are associated with responses to tilt testing
title_full Underlying hemodynamic differences are associated with responses to tilt testing
title_fullStr Underlying hemodynamic differences are associated with responses to tilt testing
title_full_unstemmed Underlying hemodynamic differences are associated with responses to tilt testing
title_sort underlying hemodynamic differences are associated with responses to tilt testing
publisher Nature Publishing Group
series Scientific Reports
issn 2045-2322
publishDate 2021-09-01
description Abstract Aim of this study was to explore whether differences in resting hemodynamic parameters may be associated with tilt test results in unexplained syncope. We analyzed age, gender, systolic (SBP), diastolic blood pressure (DBP) and heart rate (HR) by merging three large databases of patients considered likely to be of vasovagal reflex etiology, comparing patients who had tilt-induced reflex response with those who did not. Tilt-induced reflex response was defined as spontaneous symptom reproduction with characteristic hypotension and bradycardia. Relationship of demographics and baseline supine BP to tilt-test were assessed using logistic regression models. Individual records of 5236 patients (45% males; mean age: 60 ± 22 years; 32% prescribed antihypertensive therapy) were analyzed. Tilt-positive (n = 3129, 60%) vs tilt-negative patients had lower SBP (127.2 ± 17.9 vs 129.7 ± 18.0 mmHg, p < 0.001), DBP (76.2 ± 11.5 vs 77.7 ± 11.7 mmHg, p < 0.001) and HR (68.0 ± 11.5 vs 70.5 ± 12.5 bpm, p < 0.001). In multivariable analyses, tilt-test positivity was independently associated with younger age (Odds ratio (OR) per 10 years:1.04; 95% confidence interval (CI), 1.01–1.07, p = 0.014), SBP ≤ 128 mmHg (OR:1.27; 95%CI, 1.11–1.44, p < 0.001), HR ≤ 69 bpm (OR:1.32; 95%CI, 1.17–1.50, p < 0.001), and absence of hypertension (OR:1.58; 95%CI, 1.38–1.81, p < 0.001). In conclusion, among patients with suspected reflex syncope, younger age, lower blood pressure and lower heart rate are associated with positive tilt-test result.
url https://doi.org/10.1038/s41598-021-97503-0
work_keys_str_mv AT arturfedorowski underlyinghemodynamicdifferencesareassociatedwithresponsestotilttesting
AT giuliarivasi underlyinghemodynamicdifferencesareassociatedwithresponsestotilttesting
AT parisatorabi underlyinghemodynamicdifferencesareassociatedwithresponsestotilttesting
AT madeleinejohansson underlyinghemodynamicdifferencesareassociatedwithresponsestotilttesting
AT martinarafanelli underlyinghemodynamicdifferencesareassociatedwithresponsestotilttesting
AT irenemarozzi underlyinghemodynamicdifferencesareassociatedwithresponsestotilttesting
AT alicececcofiglio underlyinghemodynamicdifferencesareassociatedwithresponsestotilttesting
AT niccolocasini underlyinghemodynamicdifferencesareassociatedwithresponsestotilttesting
AT viktorhamrefors underlyinghemodynamicdifferencesareassociatedwithresponsestotilttesting
AT andreaungar underlyinghemodynamicdifferencesareassociatedwithresponsestotilttesting
AT brianolshansky underlyinghemodynamicdifferencesareassociatedwithresponsestotilttesting
AT richardsutton underlyinghemodynamicdifferencesareassociatedwithresponsestotilttesting
AT michelebrignole underlyinghemodynamicdifferencesareassociatedwithresponsestotilttesting
AT gianfrancoparati underlyinghemodynamicdifferencesareassociatedwithresponsestotilttesting
_version_ 1717755768676024320