The complexity of hemodynamic response to the tilt test with and without nitroglycerine provocation in patients with vasovagal syncope

Abstract

The paper presents a comparison of vasovagal syndrome occurrence in a head up tilt table test between patients with a positive result of passive tilt test and those with a positive result after pharmacological provocation. The study group consisted of 80 patients: 57 patients who experienced syncope in the passive phase of the test (43 women (aged: 35.6 ± 16.2) and 14 men (aged: 41.7 ± 15.6) and 23 patients who experienced syncope after pharmacological provocation (17 women (age: 32.3 ± 12) and 6 men (age: 43 ± 15). The main investigation was based on the assessment of monitored signals complexity: heart rate, blood pressure and stroke volume. The analysis of complexity in chosen measurement phases was performed with Sample Entropy. The investigation showed that the reactions of autonomic nervous system during tilt test and before syncope are similar for positive result of passive tilt test and positive result of tilt test with provocation. The differences in supine position occurred only in analysis based on impedance measurement (SV: p = 0.01). Significant differences were denoted for all signals just before the syncope (RRI, sBP, dBP: p = 0,00001 and SV: p = 0.01). In analysis of signals complexity the significant differences occurred just before the syncope for Sample Entropy of blood pressure (SampEn (sBP): p = 0.0008, SampEn (dBP): p = 0,0001).

Figure 1

The recorded parameters (RRI, sBP, dBP, SV) and phases of measurements used for calculations for the study subgroups: (a) HUTT(+) (b) HUTT(−).

Figure 2

The box-plots (mean ± SEM and mean ± 1.96·SEM) and Friedmann test with multicomparison post-hoc test in tilt test for group: (A) HUTT(+) in phase I, II and III, (B) HUTT(−) in phase I, IIa, IIb, III.

Figure 3

The box-plots (mean ± SEM and mean ± 1.96·SEM) and Mann-Whitney test for comparisons of SampEn (RRI), SampEn (sBP), SampEn (dBP), SampEn (SV) calculated for real signal and shuffled signal in successive HUTT phases for: (a) HUTT(+), (b) HUTT(−).

Figure 4

The box-plots (mean ± SEM and mean ± 1.96·SEM) and Friedmann test with multicomparison post-hoc test for SampEn (RRI), SampEn (sBP), SampEn (dBP), SampEn (SV) for the study groups: (A) HUTT(+) (B) HUTT(−).

Figure 5

The box-plots (mean ± SEM and mean ± 1.96·SEM) and Mann-Whitney test for comparisons of the study groups (HUTT(+) vs. HUTT(−) in successive HUTT phases for: (A) RRI, sBP, dBP, SV, (B) SampEn (RRI), SampEn (sBP), SampEn (dBP), SampEn (SV).

Figure 6

Comparisons of average SampEn with standard error (SEM) in sliding windows between the HUTT(+) and HUTT(−) groups in successive HUTT phases: (a) I, (b) IIa (c) III.