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. 2023 Jun 21;12(13):4202.
doi: 10.3390/jcm12134202.

Cerebral Oxygenation Responses to Standing in Young Patients with Vasovagal Syncope

Laura Pérez-Denia  1   2   3 , Paul Claffey  1   2 , Ailbhe O'Reilly  2   4 , Maria Delgado-Ortet  5 , Ciara Rice  2 , Rose Anne Kenny  1   2 , Ciarán Finucane  1   2   3
Affiliations

Cerebral Oxygenation Responses to Standing in Young Patients with Vasovagal Syncope

Laura Pérez-Denia et al. J Clin Med. .

Abstract

Vasovagal syncope (VVS) is common in young adults and is attributed to cerebral hypoperfusion. However, during active stand (AS) testing, only peripheral and not cerebral hemodynamic responses are measured. We sought to determine whether cerebral oxygenation responses to an AS test were altered in young VVS patients when compared to the young healthy controls. A sample of young healthy adults and consecutive VVS patients attending a Falls and Syncope unit was recruited. Continuous beat-to-beat blood pressure (BP), heart rate, near-infrared spectroscopy (NIRS)-derived tissue saturation index (TSI), and changes in concentration of oxygenated/deoxygenated Δ[O2Hb]/Δ[HHb] hemoglobin were measured. BP and NIRS-derived features included nadir, peak, overshoot, trough, recovery rate, normalized recovery rate, and steady-state. Multivariate linear regression was used to adjust for confounders and BP. In total, 13 controls and 27 VVS patients were recruited. While no significant differences were observed in the TSI and Δ[O2Hb], there was a significantly smaller Δ[HHb] peak-to-trough and faster Δ[HHb] recovery rate in VVS patients, independent of BP. A higher BP steady-state was observed in patients but did not remain significant after multiple comparison correction. Young VVS patients demonstrated a similar cerebral circulatory response with signs of altered peripheral circulation with respect to the controls, potentially due to a hyper-reactive autonomic nervous system. This study sets the grounds for future investigations to understand the role of cerebral regulation during standing in VVS.

Keywords: cerebral oxygenation; near-infrared spectroscopy; orthostatic; standing; syncope; young.

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Conflict of interest statement

C.F. is funded by Endotronix as part of an Industrial Partnership grant. All other authors report no conflicts of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Features extracted from TSI and SBP responses to an active stand test in a selected participant. Features extracted from the Finometer and NIRS signals (i.e., baseline, nadir, recovery rate, overshoot, and steady—state) are indicated in both graphs. The standing moment is indicated by a black vertical line at t = 0. The baseline value is indicated by a gray dashed line across the graph. SBP = systolic blood pressure, TSI = tissue saturation index.
Figure 2
Figure 2
Average TSI and SBP responses for VVS patients and controls. Average (5% trimmed mean and interquartile range) traces for SBP (mmHg) and TSI (%) relative to baseline for VVS patients (dark color, solid line) and controls (light color, dashed line). Stand occurred at t = 0, indicated by a black vertical line. VVS patients presented a higher SBP value during steady—state (average value during 60–120 s) and smaller initial drop after standing than controls. SBP = systolic blood pressure, TSI = tissue saturation index, VVS = vasovagal syncope.
Figure 3
Figure 3
Differences in TSI between patients and controls for the TSI features analyzed. TSI nadir, TSI nadir to overshoot, maximum TSI recovery rate, normalized TSI recovery rate, and TSI nadir steady—state. None of the differences were significant after correction for multiple testing (see Table 4). TSI = tissue saturation index.
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