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Small left atrial volume is an independent predictor for fainting during head-up tilt test: The impact of intracardiac volume reserve in vasovagal syncope

 Jeonggeun Moon  ;  Jaemin Shim  ;  Jae Hyung Park  ;  Hye Jin Hwang  ;  Boyoung Joung  ;  Jong-Won Ha  ;  Moon-Hyoung Lee  ;  Hui-Nam Pak 
 International Journal of Cardiology, Vol.166(1) : 44-49, 2013 
Journal Title
 International Journal of Cardiology 
Issue Date
Adult ; Atrial Function, Left/physiology* ; Cardiac Volume/physiology* ; Female ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Retrospective Studies ; Syncope/diagnosis ; Syncope/physiopathology ; Syncope, Vasovagal/diagnosis* ; Syncope, Vasovagal/physiopathology* ; Tilt-Table Test/methods* ; Young Adult
Vasovagal syncope ; Tilt test ; Echocardiography ; Left atrium
BACKGROUND: Vigorous left ventricular (LV) contraction with progressive ventricular emptying during orthostatic stress may induce hyper-responsiveness of cardiac mechanoreceptor and vasovagal syncope (VVS). We hypothesized that intracardiac volume reserve estimated by the left atrial (LA) volume index (LAVI) plays an important role in the mechanism of VVS. METHODS: A total of 234 patients (115 male, 44 ± 18 years) who underwent head-up tilt test (HTT) and transthoracic echocardiography for unexplained syncope were consecutively enrolled. Patients with a positive HTT result (HTT+; n=152) were compared with those with negative HTT response (HTT-; n=82). RESULTS: 1. Compared to HTT- patients, HTT+ patients were younger (41 ± 17 vs. 48 ± 17 years, p=0.005), included a higher number of females (56% vs. 50%, p=0.009) and showed higher basal heart rate (67 ± 12 vs. 63 ± 11 bpm, p=0.047). 2. LAVI (20 ± 5 vs. 26 ± 13 ml/m(2), p<0.001), LV end-diastolic dimension (47.4 ± 3.7 vs. 49.0 ± 4.1mm, p=0.015), and the proportion of LV hypertrophy (13% vs. 24%, p=0.027) were smaller and early diastolic mitral annulus velocity was higher (9.7 ± 3.0 vs. 8.5 ± 2.6 cm/s, p=0.004) in HTT+ patients than those in HTT- group. 3. LAVI (OR 0.917 (0.860-0.977), p=0.007) was the only independent predictor of HTT induced VVS, and LAVI had a linear correlation with time to syncope during HTT (r=0.39, p=0.034). In addition, patients with LAVI ≥ 36 ml/m(2) did not faint during HTT. CONCLUSION: Small LA volume is an independent predictor of HTT-induced VVS. Limited intracardiac volume reserve might play an important role in the mechanism of VVS.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
Park, Jae Hyung(박재형)
Pak, Hui Nam(박희남) ORCID logo https://orcid.org/0000-0002-3256-3620
Shim, Jae Min(심재민)
Lee, Moon Hyoung(이문형) ORCID logo https://orcid.org/0000-0002-7268-0741
Joung, Bo Young(정보영) ORCID logo https://orcid.org/0000-0001-9036-7225
Ha, Jong Won(하종원) ORCID logo https://orcid.org/0000-0002-8260-2958
Hwang, Hye Jin(황혜진)
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