International Journal of Cardiovascular Sciences. 21/mar/2024;37:e20230017.

Quality of Life After Diagnosis of Neurally Mediated Reflex Syncope by Tilt Test

Claudia Madeira Miranda ORCID logo , Rose Mary Ferreira Lisboa da Silva ORCID logo , Edson Del Amore Filho ORCID logo , Izabela Maria Azeredo Nascimento, Pedro Santos Carvalho ORCID logo

DOI: 10.36660/ijcs.20230017

Este Artigo Original é referido pelo Editorial "Assessment of Quality of Life after Diagnosis of Reflex Syncope: A Subjective Outcome of Great Clinical Importance with Multifactorial Cause".

Abstract

Background:

Vasovagal syncope (VVS) results in impaired quality of life (QoL). The response during the head-up tilt test (HUTT) influences QoL and recurrence.

Objectives:

To analyze the influence of the type of HUTT response on QoL in patients with VVS and recurrence of events after the exam.

Methods:

The SF-36 and Impact of Syncope on Quality of Life (ISQL) questionnaires were applied over 12 months after the HUTT. Unpaired Student’s t test was used for differences between 2 groups of quantitative data with normal distribution. The recurrence of syncope episodes was analyzed using a Kaplan-Meier curve, and the log-rank test was applied to compare the curves regarding responses to the HUTT. Statistical significance was set at p value < 0.05.

Results:

We analyzed 82 patients (43.7 years old), 69% with previous recurrence (2.8 prior episodes). Cardioinhibitory response occurred in 46 patients; vasodepressor response occurred in 36, and 85.4% of patients received non-pharmacological treatment after the HUTT. During clinical follow-up, 43.9% had recurrence, mainly young patients (35.7 years; p = 0.002). On the SF-36, the best score was in functional capacity in men (p = 0.04) and patients without prior trauma (p = 0.001). There were lower limitations due to pain in patients without prior trauma (p = 0.003) and patients without prodromes (p = 0.009). On the ISQL, there were better mean scores in men (p = 0.002) and in patients without prior trauma (p = 0.02). Patients with cardioinhibitory response had better SF-36 and ISQL scores (p < 0.001). There was greater VVS recurrence in the cardioinhibitory response group (log-rank p = 0.011; hazard ratio: 8.48; 95% confidence interval: 7.59 to 9.3) from the second to the fourth month, with stabilization in the eighth month after the HUTT, when compared to patients with vasodepressor response.

Conclusion:

The majority of patients with VVS reproduced during the HUTT under non-pharmacological treatment did not report worsening of QoL during clinical follow-up. Worse QoL was observed in non-young patients and in patients with vasodepressor response, and it was not influenced by recurrence after the HUTT.

Quality of Life After Diagnosis of Neurally Mediated Reflex Syncope by Tilt Test

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