Baroreflex circulation regulation during tilt test in young males with a history of vasovagal syncopes

Background. Vasovagal syncopes (VVS) are relatively often recorded in the population of young people. Objective. To establish the changes in the baroreflex function during the tilt test in healthy young males with the history of VVS. Design and methods. A total of 102 people aged 18–30 years were examined and divided into 4 groups, taking into account the specific features of fainting history and response to the tilt test. Subjects of the group 1 (n = 14) had a history of VVS and a positive response to the tilt test (syncope). Subjects of the group 2 (n = 14) had a history of VVS and a pattern of postural tachycardia without fainting verified during the tilt test. Subjects of the group 3 (n = 42) had a history of VVS and a negative response to the tilt test. Subjects of the group 4 (n = 32) did not have a history of VVS and showed a negative response to the tilt test. During the tilt test, we studied the dynamics of the baroreflex functional parameters (the number of baroreflex reactions (NBR), the baroreflex effectiveness index (BEI), the baroreflex sensitivity (BRS)). Results. In the individuals of each group, in the initial horizontal phase, values of NBR, BEI, BRS were within normal range and did not show significant intergroup differences (p > 0,05). The passive orthostasis was associated with the increase in NBR (in each group beside control group), a decrease in BEI and BRS. The increase in NBR in the vertical phase of the tilt test (relative to the initial horizontal phase) was 87 %, 6 %, 16 % in the groups 1, 2, 3 and 4, respectively. The tilt-induced decrease in NBR comprised 8 % in the group 4. The decrease in the BEI in the vertical phase of the tilt test (relative to the initial horizontal phase) consisted: 22 %, 19 %, 12 %, 10 % in subjects of the 1, 2, 3, 4 groups, respectively. During the passive orthostasis we observed a decrease in BRS: by 65 %, 69 %, 64 %, 57 % in individuals of the groups 1, 2, 3 and 4, respectively. Returning from a vertical to a horizontal position in all groups led to a pronounced decrease in NBR and an increase in the BEI to values lower than in baseline horizontal tilt test phase; to an excessive increase in the BRS exceeding the pre-test values in each study group. Conclusions. In prolonged passive orthostasis, healthy young males, regardless of the fainting history, demonstrate a decrease in the baroreflex regulation. Among those with the history of VVS, tilt-positive subjects are characterized by a more pronounced orthostasis-induced drop in the baroreflex sensitivity and the baroreflex effectiveness index and a slow recovery of the baroreflex regulatory function compared to the tilt-negative subjects and to those who demonstrated postural tachycardia pattern without syncope.

1. Barsukov AV, Glukhovskoy DV, Chepcheruk OG, Didenko MV, Bobrov AL. Syncopes as a sphere of professional interests of a cardiologist. Vestn Ross Mil Med Acad. 2016;3(55):251–259. In Russian.

2. Brignole M, Moya A, de Lange FJ, Deharo JC, Elliott PM, Fanciulli A et al. 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J. 2018;39(21):1883–1948. doi:10.1093/eurheartj/ehy037

3. Mosqueda-Garcia R, Furlan R, Tank J, Fernandez-Violante R. The elusive pathophysiology of neurally mediated syncope. Circulation. 2000;102 (23):2898–2906. doi: org/10.1161/01.CIR.102.23.2898

4. Sheldon RS, Grubb BP II, Olshansky B, Shen WK, Calkins H, Brignole M et al. 2015 Heart Rhythm Society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope. Heart Rhythm 2015;12(6):41–63. doi:10.1016/j.hrthm.2015.03.029

5. Iacoviello M, Forleo C, Guida P et al. Independent role of reduced arterial baroreflex sensitivity during head-up tilt testing in predicting vasovagal syncope recurrence. Europace. 2010;12 (8):1149–1155. doi:10.1093/europace/euq149

6. Barsukov AV, Glukhovskoy DV, Chepcheruk OG, Didenko MV, Bobrov AL. Syncopes as a sphere of professional interests of a cardiologist. Vestn Ross Mil Med Acad. 2016;3(55):251–259. In Russian.

7. Moya A, Sutton R, Ammirati F, Blanc JJ, Brignole M, Dahm JB et al. Guidelines for the diagnosis and management of syncope (version 2009): the Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology. Eur Heart J. 2009;30(21):2631–2671. doi:10.1093/eurheartj/ehp298

8. Mosqueda-Garcia R, Furlan R, Tank J, Fernandez-Violante R. The elusive pathophysiology of neurally mediated syncope. Circulation. 2000;102 (23):2898–2906. doi: org/10.1161/01.CIR.102.23.2898

9. Di Rienzo M, Parati G, Castiglioni P, Tordi R, Mancia G, Pedotti A. Baroreflex effectiveness index: an additional measure of baroreflex control of heart rate in daily life. Am J Physiol Regul Integr Comp Physiol. 2001;280(3):744–751.

10. Iacoviello M, Forleo C, Guida P et al. Independent role of reduced arterial baroreflex sensitivity during head-up tilt testing in predicting vasovagal syncope recurrence. Europace. 2010;12 (8):1149–1155. doi:10.1093/europace/euq149

11. Brignole M, Menozzi C, Del Rosso A, Costa S, Gaggioli G, Bottoni N et al. New classification of haemodynamics of vasovagal syncope: beyond the VASIS classification. Analysis of the presyncopal phase of the tilt test without and with nitroglycerin challenge. Vasovagal Syncope International Study. Europace. 2000;2(1):66–76.

12. Moya A, Sutton R, Ammirati F, Blanc JJ, Brignole M, Dahm JB et al. Guidelines for the diagnosis and management of syncope (version 2009): the Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology. Eur Heart J. 2009;30(21):2631–2671. doi:10.1093/eurheartj/ehp298

13. Gribbin B, Pickering TG, Sleight P, Peto R. Effect of age and high blood pressure on baroreflex sensitivity in man. Circ Res. 1971;29(4):424–431.

14. Di Rienzo M, Parati G, Castiglioni P, Tordi R, Mancia G, Pedotti A. Baroreflex effectiveness index: an additional measure of baroreflex control of heart rate in daily life. Am J Physiol Regul Integr Comp Physiol. 2001;280(3):744–751.

15. Zyuzina NE. Condition of baroreflex regulation in patients with vasovagal syncopes: PhD thesis: 14.01.05. M., 2015: 106. In Russian.

16. Brignole M, Menozzi C, Del Rosso A, Costa S, Gaggioli G, Bottoni N et al. New classification of haemodynamics of vasovagal syncope: beyond the VASIS classification. Analysis of the presyncopal phase of the tilt test without and with nitroglycerin challenge. Vasovagal Syncope International Study. Europace. 2000;2(1):66–76.

17. Iacoviello M, Guida P, Forleo C, Sorrentino S, D’Alonzo L, Favale S. Impaired arterial baroreflex function before nitrate168 induced vasovagal syncope during head-up tilt test. Europace. 2008;10(10):1170–1175. doi:10.1093/europace/eun217

18. Gribbin B, Pickering TG, Sleight P, Peto R. Effect of age and high blood pressure on baroreflex sensitivity in man. Circ Res. 1971;29(4):424–431.

19. Pitzalis M, Parati G, Massari F, Guida P, Di Rienzo M, Rizzon B et al. Enhanced reflex response to baroreceptor deactivation in subjects with tilt-induced syncope. Jam Coll Cardiol. 2003;41(7):1167–1173.

20. Zyuzina NE. Condition of baroreflex regulation in patients with vasovagal syncopes: PhD thesis: 14.01.05. M., 2015: 106. In Russian.

21. Samniah N, Sakaguchi S, Ermis C, Lurie KG, Benditt DG. Transient modification of baroreceptor response during tiltinduced vasovagal syncope. Europace. 2004;6(1):48–54.

22. Iacoviello M, Guida P, Forleo C, Sorrentino S, D’Alonzo L, Favale S. Impaired arterial baroreflex function before nitrate168 induced vasovagal syncope during head-up tilt test. Europace. 2008;10(10):1170–1175. doi:10.1093/europace/eun217

23. Mitro P, Simurda M, Evin L, Murin P, Muller E. Reduced baroreflex sensitivity in patients with vasovagal syncope. Bratisl Lek Listy. 2015;116(10):582–586.

24. Pitzalis M, Parati G, Massari F, Guida P, Di Rienzo M, Rizzon B et al. Enhanced reflex response to baroreceptor deactivation in subjects with tilt-induced syncope. Jam Coll Cardiol. 2003;41(7):1167–1173.

25. Sneddon JF, Bashir Y, Murgatroyd FD, Ward DE, Camm AJ, Malik M. Do patients with neurally mediated syncope have augmented vagal tone? Am J Cardiol. 1993;72(17):1314–1315.

26. Samniah N, Sakaguchi S, Ermis C, Lurie KG, Benditt DG. Transient modification of baroreceptor response during tiltinduced vasovagal syncope. Europace. 2004;6(1):48–54.

27. Chaddha A, Wenzke KE, Brignole M, Wasmund SL, Page RL, Hamdan MH. The role of the baroreflex in tilt table testing: outcome and type of response. JACC: Clin Electrophysiol. 2016;2(7):812–817. doi:10.1016/j.jacep.2016.05.001

28. Mitro P, Simurda M, Evin L, Murin P, Muller E. Reduced baroreflex sensitivity in patients with vasovagal syncope. Bratisl Lek Listy. 2015;116(10):582–586.

29. Lee SH, Yang JH, Yim HR, Park J, Park SJ, Park KM et al. Hemodynamic parameters and baroreflex sensitivity during headup tilt test in patients with neurally mediated syncope. Pacing Clin Electrophysiol. 2017;40(12):1454–1461. doi:10.1111/pace.13217

30. Sneddon JF, Bashir Y, Murgatroyd FD, Ward DE, Camm AJ, Malik M. Do patients with neurally mediated syncope have augmented vagal tone? Am J Cardiol. 1993;72(17):1314–1315.

31. Kardos A, Rudas L, Simon J, Gingl Z, Csanády M. Effect of postural changes on arterial baroreflex sensitivity assessed by the spontaneous sequence method and Valsalva manoeuvre in healthy subjects. Clin Auton Res. 1997;7(3):143–148.

32. Chaddha A, Wenzke KE, Brignole M, Wasmund SL, Page RL, Hamdan MH. The role of the baroreflex in tilt table testing: outcome and type of response. JACC: Clin Electrophysiol. 2016;2(7):812–817. doi:10.1016/j.jacep.2016.05.001

33. Laitinen T, Hartikainen J, Vanninen E, Niskanen L, Geelen G, Länsimies E. Age and gender dependency of baroreflex sensitivity in healthy subjects. J Appl Physiol. 1998;84(2):576–583.

34. Lee SH, Yang JH, Yim HR, Park J, Park SJ, Park KM et al. Hemodynamic parameters and baroreflex sensitivity during headup tilt test in patients with neurally mediated syncope. Pacing Clin Electrophysiol. 2017;40(12):1454–1461. doi:10.1111/pace.13217

35. Cooper VL, Hainsworth R. Effects of head-up tilting on baroreceptor control in subjects with different tolerances to orthostatic stress. Clin Sci. 2002;103(3):221–226.

36. Kardos A, Rudas L, Simon J, Gingl Z, Csanády M. Effect of postural changes on arterial baroreflex sensitivity assessed by the spontaneous sequence method and Valsalva manoeuvre in healthy subjects. Clin Auton Res. 1997;7(3):143–148.

37. Bogachev MI, Mamontov OV, Konradi AO, Uljanitsky YuD. Assessment of spontaneous arterial baroreflex by the method of joint analysis of indicators of short-term variability of blood pressure and heart rate. Arterial’naya Gipertenziya = Arterial Hypertension. 2007;13 (1):69–75. In Russian.

38. Laitinen T, Hartikainen J, Vanninen E, Niskanen L, Geelen G, Länsimies E. Age and gender dependency of baroreflex sensitivity in healthy subjects. J Appl Physiol. 1998;84(2):576–583.

39. Victor RG, Mark AL. Interaction of cardiopulmonary and carotid baroreflex control of vascular resistance in humans. J Clin Invest. 1985;76(4):1592–1598.

40. Cooper VL, Hainsworth R. Effects of head-up tilting on baroreceptor control in subjects with different tolerances to orthostatic stress. Clin Sci. 2002;103(3):221–226.

41. Fauvel JP, Cerutti C, Quelin P, Laville M, Gustin MP, Paultre CZ et al. Mental stress-induced increase in blood pressure is not related to baroreflex sensitivity in middle-aged healthy men. Hypertension. 2000;35(4):887–891.

42. Bogachev MI, Mamontov OV, Konradi AO, Uljanitsky YuD. Assessment of spontaneous arterial baroreflex by the method of joint analysis of indicators of short-term variability of blood pressure and heart rate. Arterial’naya Gipertenziya = Arterial Hypertension. 2007;13 (1):69–75. In Russian.

43. Victor RG, Mark AL. Interaction of cardiopulmonary and carotid baroreflex control of vascular resistance in humans. J Clin Invest. 1985;76(4):1592–1598.

44. Fauvel JP, Cerutti C, Quelin P, Laville M, Gustin MP, Paultre CZ et al. Mental stress-induced increase in blood pressure is not related to baroreflex sensitivity in middle-aged healthy men. Hypertension. 2000;35(4):887–891.