Transcranial Doppler monitoring during head upright tilt table testing in patients with suspected neurocardiogenic syncope

The aim of the present study was to evaluate the mechanism of cerebrovascular autoregulation in patients with neurocardiogenic syncope using bilateral transcranial Doppler (TCD) monitoring during head upright tilt table testing (HUT). Two hundred and six patients were prospectively studied. One hund...

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Bibliographic Details
Published in:Europace (London, England) England), 2004-01, Vol.6 (1), p.63-69
Main Authors: Albina, Gastón, Fernandez Cisneros, Lucía, Laiño, Rubén, Nobo, Ulises L, Ortega, Daniel, Schwarz, Elena, Barja, Luis, Lagos, Roberto, Giniger, Alberto, Ameriso, Sebastián F
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Blood Flow Velocity
Cerebrovascular Circulation - physiology
Child
Female
Humans
Male
Middle Aged
Syncope, Vasovagal - diagnosis
Syncope, Vasovagal - diagnostic imaging
Syncope, Vasovagal - physiopathology
Tilt-Table Test
Ultrasonography, Doppler, Transcranial
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Summary:The aim of the present study was to evaluate the mechanism of cerebrovascular autoregulation in patients with neurocardiogenic syncope using bilateral transcranial Doppler (TCD) monitoring during head upright tilt table testing (HUT). Two hundred and six patients were prospectively studied. One hundred and fifty-nine subjects (77%) had a prior history of syncope and 47 (23%) had presyncope. Ninety-nine patients (48%) had syncope or presyncope during HUT with a 76% fall in diastolic middle cerebral artery blood flow velocity (D-MCA-BFV). Systolic MCA-BFV (S-MCA-BFV) fell by 33%. Deepening of the dicrotic notch in the Doppler waveform always preceded the fall in D-MCA-BFV. Patients without syncope or presyncope (n=96) had smaller changes in cerebral blood flow velocities during HUT and only twenty-two subjects had transient deepening of the dicrotic notch. Eleven subjects had presyncope during HUT due to an exaggerated response to nitrates with progressive arterial hypotension without bradycardia and changes during TCD monitoring that were intermediate between positive and negative HUT. In conclusion, patients with neurocardiogenic syncope have changes in cerebral blood flow during the event. TCD monitoring during HUT helps to assess these alterations.
ISSN:1099-5129
DOI:10.1016/j.eupc.2003.09.009