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Clin. Cardiol. 23, 825–830 (2000)

Increased Arterial Wave Reflection May Predispose Syncopal Attacks

Chen-Huan Chen, M.D., Han-Hwa Hu, M.D., Yao-Ping Lin, M.D., Chang-Ming Chern, M.D., Tsei-Lieh Hsu, M.D., Philip Yu-An Ding, M.D., Ph.D.

Department of Medicine and Center of Neuroscience, Taipei Veterans General Hospital, and Department of Social Medicine and Center of Cardiovascular Research, National Yang-Ming University, Taipei, Taiwan

Summary

Background: The incidence of syncope increases with age, while aging is also associated with increased arterial wave reflection.

Hypothesis: The study was undertaken to determine whether increased arterial wave reflection is a predisposing factor of syncope.

Methods: We recruited 38 patients (28 men and 10 women, mean age 57.2 ± 20.3 years, range 17–87 years) with a history of syncope within 6 months of entry. The etiology of syncope was documented for each patient by a complete assessment of vasomotor function and cerebral flow. All patients received a comprehensive echocardiographic evaluation of cardiac structure and function. Carotid augmentation index (AI) was estimated noninvasively with the tonometry technique. The results were compared with those from 54 age- and gender-matched controls.

Results: The most frequent diagnoses of syncope were postural hypotension (13 patients) and cerebrovascular dysautoregulation (10 patients), and the cause could not be determined in 9 patients. Compared with the control group, the syncope group had a greater AI (20 ± 21 vs. 10 ± 15%, p = 0.013). Subgroup analysis of 20 patients aged >50 years and with the aforementioned diagnoses showed even more striking results: AI, 29 ± 10 vs. 11 ± 15%, p<0.001. The enhanced augmentation in the patients remained when age, systolic blood pressure, height, and heart rate were accounted for. Analysis of the carotid pulse wave suggested that both the timing and intensity of wave reflection were enhanced in patients with a history of syncope compared with controls.

Conclusions: Our results support the hypothesis that enhanced arterial wave reflection is associated with the occurrence of syncope, especially in the elderly.

Key words: syncope, aging, arterial stiffness

This work was supported by a grant from the VGH-NYMU Joint Research Program, (VGHYM-T1-01), Tsou's Foundation, ROC.

Address for reprints:
Chen-Huan Chen, M.D.
201 Shih-Pai Road, Sec. 2.
Division of Cardiology, Department of Medicine
Taipei Veterans General Hospital
Taipei, Taiwan

Received: October 6, 1999
Accepted with revision: January 26, 2000


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