BRAIN DESATURATION DURING HEAD-UP TILT TEST IN TEENAGERS WITH VASOVAGAL SYNCOPE
B. Pietrucha, A.Z. Pietrucha, M. Wnuk, I. Bzukala, E. Konduracka, W. Piwowarska, A. Rudzinski, J. Nessler
1. Children Cardiology Department, Children University Hospital, Jagiellonian University Medical College, Cracow, Poland; 2. Syncope Unit, Department of Coronary Disease and Heart Failure, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Cracow, Poland
Introduction: Brain hypoperfusion causing the syncope may lead to changes in the brain tissue. Is there some differences between teenagers response to the brain hypoperfusion in relation to older group of patients with syncope.
The aim of study: analysis of changes of cerebral regional oxygen saturation (rSO2) measured by near infra-red spectroscopy (NIRS) during head-up tilt test (HUTT) in young patients with vasovagal syncope (VVS).
Methods: Study population: 175 young pts. (123 girls) aged 12-18yrs (Group I) and 385 adult patients (266 women) – Group II - with VVS referred to HUTT.
Methods: All pts underwent HUTT according standard Westminster protocol. During HUTT rSO2 of frontal lobes of brain was measured using INVOS cerebral oximeter in all pts. Baseline value of rSO2 was evaluated during 15 min. supine phase before HUTT. Changes of rSO2 during HUTT was expressed as a relative decrease (in%) of rSO2 in left and right channels. Area limited by curve of rSO2 and baseline level of rSO2 during HUTT (rSO2-AUC), mean (rSO2-mean) and maximal (rSO2-max) desaturation during the test was also analyzed in all patients.
Results: HUTT was positive in 152 pts. from group I (86,8%) and 309 pts. from group II (80,2%). Significant desaturation preceded syncope induction during HUTT in all pts in comparison to pts with negative test (-29.9 and -32,1 % vs -11,5 and -12,3 % p< 0,00001). Higher values of mean desaturation and area limited by the desaturation curves were observed in teenagers in comparison to adult pts. with vasovagal syncope induced by HUTT. (rSO2-mean L 7,9% vs 5,6%; rSO2-mean R 7,8% vs 5,5%, p< 0,02; rSO2-AUC 189,2 vs 152,6 %min; 207,3 vs 151,1%min, p < 0,015). There were no significant differences of maximal desaturation between both groups.
Conclusions: 1. Higher cerebral desaturations were observed during syncope induced by Head-Up Tilt Test in teenagers than in adult people.
2. Higher brain desaturations caused by hypoperfusion leading to reflex syncope in young patients might be a potential injuring factor for the nervous tissue in this group of patients.
