A higher peak heart rate during head-up tilt test predicts the therapeutic efficacy of metoprolol in vasovagal syncope

• Published in: BMC cardiovascular disorders 2024-10, Vol.24 (1), p.576-8, Article 576
• Main Authors: Liu, Kemei, Liu, Pengyu, Huang, Zhuoshan, Wu, Lin, Xie, Xujing, Liu, Jinlai, Zhu, Jieming, Liang, Yuen, Dong, Ruimin
• Format: Article
• Language: English
• Subjects: Adrenergic beta-1 Receptor Antagonists - therapeutic use; Adult; Beta blockers; Blood pressure; Blood Pressure - drug effects; Cardiovascular disease; Care and treatment; Comorbidity; Complications and side effects; Consciousness; Dosage and administration; Drug therapy; Fainting; Female; Health aspects; Heart beat; Heart rate; Heart Rate - drug effects; Hemodynamics; Humans; Ischemia; Male; Metoprolol; Metoprolol - therapeutic use; Middle Aged; Normal distribution; Patient outcomes; Patients; Physiology; Predictive Value of Tests; Predictors; Reperfusion injury; Retrospective Studies; Syncope, Vasovagal - diagnosis; Syncope, Vasovagal - drug therapy; Syncope, Vasovagal - physiopathology; Tilt-Table Test; Time Factors; Treatment Outcome; Vasovagal syncope; Young Adult
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-024-04249-4

Although beta blockers, such as metoprolol, have been widely used in the management of vasovagal syncope (VVS), their efficacy remains debated, with larger studies showing limited benefit. Identifying patient-specific characteristics that predict a positive response to metoprolol could optimize its use. This study aims to investigate the key factors that may determine which VVS patients are suitable candidates for metoprolol treatment. This retrospective study was conducted at a single center. Patients diagnosed with VVS and treated with metoprolol for a minimum of three months were included. A 50% reduction in syncope symptom score (SS) after three months of metoprolol treatment was used to define metoprolol responders, while those who did not achieve this reduction were classified as non-responders. After a three-month follow-up, patients were divided into two groups: responders and non-responders. Baseline data-including age, gender, comorbidities, laboratory tests, and the type of VVS-were analyzed for each patient. Changes in heart rate (HR) and blood pressure during the head-up tilt test (HUTT) were also evaluated between the two groups. Logistic regression analysis was performed to identify potential predictors of metoprolol response, and receiver operating characteristic (ROC) curve analysis was used to assess the value of these predictors in selecting potential responders. A total of 168 VVS patients were enrolled between January 2016 and December 2020. Of these, 100 patients responded positively to metoprolol, while 68 did not. No significant differences in baseline characteristics or HUTT results were observed between the two groups (p > 0.05). However, responders exhibited a significantly higher peak HR compared to non-responders during the HUTT (120.13 ± 19.33 vs. 106.60 ± 22.32, p