Nörokardiyojenik Senkoplu Hastalarda Tilt Testi Öncesi ve Sonrasında Arteriyel Nabız Dalga Hızının Değerlendirilmesi

Abstract

Syncope is defined as loss of conciousness caused by transient decrease in the blood flow to the brain. Syncope that is not related with structural heart diseases but caused by clinical conditions which induce neural reflexes that results in loss of conciousness and postural tonus are called neurocardiogenic syncope. Tilt table testing is the most important test used in diagnosis of neurocardiogenic syncope in medical practice. Sensitivity of tilt table testing is found to be between % 32-85 and specificity is between % 80-90 in medical studies. lately, mild to moderate correlation between parasympathetic nervous system and pulse wave velocity (PWV) has been shown. In previous trials, predictive value of PWV on cardiovascular mortality and coronary artery disease, has been shown to be better, regardless of classical risk factors. In our study, we investigated if PWV can detect the increased parasympathetic activity responsible for syncope by leading to bradycardia and hypotension. So we tested if patients with syncope have higher PWV due to increased parasympathetic activity, in comparison with healthy population and if amytriptilin 10 mg has any effect on PWV values after being initiated in order to prevent syncopes. Systolic Blood Pressure (SBP), Mean Blood Pressure (MBP), Central Systolic Blood Pressure (CSBP), Diastolic Blood Pressure (DBP), Central Diastolic Blood Pressure (CDBP), Augmentation Index (Aix), Heart Rate (HR), Pulse Pressure (PP), Cardiac Output (CO), Peripheral Vascular Impedance (PVI) and Reflection Size (RS) parameters were also assessed by Arteriograph appliance beyond PWV. Patients with neurocardiogenic syncope had significantly higher PWV compared with healty controls [5,7 ve 5,2, p=0,005, respectively]. But there was no significant difference between the two groups after the initiation of amytriptilin treatment, in the 1., 3. and 6. months of the follow-up. [5.7, 5.8, 5.9 ve 5.8, p=0.56, respectively]. Other basic parameters showed no significant differnce between two groups but in neurocardiogenic syncope group; levels of SBP, DBP, MBP, HR, MSBP, MDBP, CO and RS significantly increased during follow up, after amytriptilin 10 mg treatment [114, 121, 128, 134 mmHg, p=0.02; 74, 80, 86, 91 mmHg, p=0.01; 92, 99, 100, 105 mmHg, p=0.04; 76, 84, 92, VI 99/min, p=0.02; 102, 109, 115, 120 mmHg, p=0.03; 74, 80, 86, 95 mmHg, p= 0.02; 4.1, 4.4, 4.7, 4,9 lt/min, p= 0.03; 56, 61, 62, 68, p=0.03, respectively]. However, in the levels of RS, PP, Aix and PVI there have not been noticed significant changes. According to these results, PWV correlates with tilt table test positivity with a %72 sensivity and %84 spesificity in the diagnosis of neurocardiogenic syncope when an upper limit of 5,45 m/s was defined. As a result, PWV can effectively be utilised fort he diagnosis of neurocardiogenic syncope but it isn’t appropriate for follow-up of patients receiving amytriptilin treatment.