DOI QR코드

DOI QR Code

Assessment of cardiac function in syncopal children without organic causes

  • 투고 : 2019.08.27
  • 심사 : 2021.02.15
  • 발행 : 2021.11.15

초록

Background: Syncope is a common problem in children and adolescents. However, a large proportion of syncope cases have no underlying cause. Purpose: This study aimed to identify the factors affecting the severity of syncope using tissue Doppler imaging (TDI). Methods: This retrospective study included 61 children and adolescents with syncope who underwent echocardiography. The head-up-tilt test (HUT) was performed when there was a more severe syncopal event. We compared the echocardiographic findings between the execute HUT and nonexecute HUT, negative HUT result and positive HUT result, and normal electrocardiogram (ECG) and abnormal ECG groups. Data were analyzed using an unpaired t test post hoc analysis. Results: In the execute and nonexecute HUT groups, the odds ratios were 0.55 for medial E/E' (P=0.040) and 0.64 for lateral E/E' (P=0.049). Comparison of the results of the decreased, normal, and increased groups for lateral E/E' revealed a significant difference in the execution HUT and nonexecute HUT groups (overall, P=0.004; decreased vs. increased, P=0.003; normal vs. increased, P=0.050). Conclusion: Medial E/E' and lateral E/E' were decreased in patients with severe syncopal events. These findings suggest that the presence of left ventricular diastolic deterioration may cause hypoperfusion even in the absence of organic causes and, consequently, increase syncope severity and frequency. The TDI measured by echocardiography can be used as an index to predict syncope recurrence and/or severity.

키워드

참고문헌

  1. Brignole M, Moya A, de Lange FJ, Deharo JC, Elliott PM, Fanciulli A, et al. 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J 2018;39:1883-948. https://doi.org/10.1093/eurheartj/ehy037
  2. Friedman KG, Alexander ME. Chest pain and syncope in children: a practical approach to the diagnosis of cardiac disease. J Pediatr 2013;163:896-901. https://doi.org/10.1016/j.jpeds.2013.05.001
  3. Anderson JB, Willis M, Lancaster H, Leonard K, Thomas C. The Evaluation and Management of Pediatric Syncope. Pediatr Neurol 2016;55:6-13. https://doi.org/10.1016/j.pediatrneurol.2015.10.018
  4. Fu Q, Levine BD. Pathophysiology of neurally mediated syncope: role of cardiac output and total peripheral resistance. Auton Neurosci 2014;184:24-6. https://doi.org/10.1016/j.autneu.2014.07.004
  5. Barbic F, Dipaola F, Casazza G, Borella M, Minonzio M, Solbiati M, et al. Syncope in a working-age population: recurrence risk and related risk factors. J Clin Med 2019;8:150. https://doi.org/10.3390/jcm8020150
  6. Yu CM, Sanderson JE, Marwick TH, Oh JK. Tissue Doppler imaging a new prognosticator for cardiovascular diseases. J Am Coll Cardiol 2007;49:1903-14. https://doi.org/10.1016/j.jacc.2007.01.078
  7. Raddino R, Zanini G, Robba D, Bonadei I, Chieppa F, Pedrinazzi C, et al. Diagnostic value of the head-up tilt test and the R-test in patients with syncope. Heart Int 2006;2:171. https://doi.org/10.4081/hi.2006.171
  8. Choi SH, Eun LY, Kim NK, Jung JW, Choi JY. Myocardial tissue Doppler velocity in child growth. J Cardiovasc Ultrasound 2016;24:40-7. https://doi.org/10.4250/jcu.2016.24.1.40
  9. Dallaire F, Slorach C, Hui W, Sarkola T, Friedberg MK, Bradley TJ, et al. Reference values for pulse wave Doppler and tissue Doppler imaging in pediatric echocardiography. Circ Cardiovasc Imaging 2015;8:e002167. https://doi.org/10.1161/CIRCIMAGING.114.002167
  10. Caballero L, Kou S, Dulgheru R, Gonjilashvili N, Athanassopoulos GD, Barone D, et al. Echocardiographic reference ranges for normal cardiac Doppler data: results from the NORRE Study. Eur Heart J Cardiovasc Imaging 2015;16:1031-41.
  11. Shen WK, Jahangir A, Beinborn D, Lohse CM, Hodge DO, Rea RF, et al. Utility of a single-stage isoproterenol tilt table test in adults: a randomized comparison with passive head-up tilt. J Am Coll Cardiol 1999;33:985-90. https://doi.org/10.1016/S0735-1097(98)00658-5
  12. Kadappu KK, Thomas L. Tissue Doppler imaging in echocardiography: value and limitations. Heart Lung Circ 2015;24:224-33. https://doi.org/10.1016/j.hlc.2014.10.003
  13. Previtali M, Chieffo E, Ferrario M, Klersy C. Is mitral E/E' ratio a reliable predictor of left ventricular diastolic pressures in patients without heart failure? Eur Heart J Cardiovasc Imaging 2012;13:588-95. https://doi.org/10.1093/ejechocard/jer286
  14. Wieling W, Thijs RD, van Dijk N, Wilde AA, Benditt DG, van Dijk JG. Symptoms and signs of syncope: a review of the link between physiology and clinical clues. Brain 2009;132(Pt 10):2630-42. https://doi.org/10.1093/brain/awp179
  15. Samdani AJ, Samdani H, Mohammed M, Kattel S, Meesala M, Saito Y. Left ventricular diastolic dysfunction is more common in patients with syncope. J Am Coll Cardiol 2015;65 (10_Supplement):A434. https://doi.org/10.1016/S0735-1097(15)60434-X
  16. Yamaguchi Y, Mizumaki K, Nishida K, Sakamoto T, Nakatani Y, Kataoka N, et al. Vasovagal syncope is associated with poor prognosis in patients with left ventricular dysfunction. Heart Vessels 2018;33:421-6. https://doi.org/10.1007/s00380-017-1078-0
  17. Schwarzwald CC, Schober KE, Bonagura JD. Methods and reliability of tissue Doppler imaging for assessment of left ventricular radial wall motion in horses. J Vet Intern Med 2009;23:643-52. https://doi.org/10.1111/j.1939-1676.2009.0287.x