A higher proportion of men than of women fainted in the phase without nitroglycerin in tilt-induced vasovagal syncope
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RESEARCH ARTICLE
A higher proportion of men than of women fainted in the phase without nitroglycerin in tilt‑induced vasovagal syncope Maryam Ghariq1 · Roland D. Thijs1,2 · L. Martine Bek1 · Erik W. van Zwet3 · David G. Benditt4 · J. Gert van Dijk1 Received: 17 September 2019 / Accepted: 6 January 2020 © The Author(s) 2020
Abstract Purpose Vasovagal syncope (VVS) affects more women than men. We determined whether this sex ratio affects tilt table test (TTT) results. Methods We retrospectively studied TTT outcomes in suspected VVS. TTT consisted of supine rest, a maximum 20 min of head-up tilt without and, if nitroglycerin was needed, a further maximum 20 min after nitroglycerin administration. TTT was terminated if VVS occurred. We used binary logistic regression for the entire TTT and for each phase, with VVS as outcome and age and sex as predictors. Results TTT provoked vasovagal (pre)syncope in 494 out of 766 tests (64%). The proportion of men and women who fainted during the entire TTT did not differ significantly between the sexes (p = 0.13, corrected for age). A lower proportion of women than men had VVS in the phase without nitroglycerin (odds ratio 0.54; 95% confidence interval 0.37–0.79; p = 0.002, corrected for age), whereas a higher proportion of women than men fainted after nitroglycerin (odds ratio 1.58; 95% confidence interval 1.13–2.21; p = 0.008, corrected for age). These sex differences remained significant after correction for a history of orthostatic versus emotional triggers. The effect of sex on TTT outcome was closely associated with differences of blood pressure change upon tilt-up (lower in men in both TTT phases: without nitroglycerin p = 0.003; with nitroglycerin p = 0.05), but not with heart rate changes. Conclusion Men were more susceptible to induction of VVS without nitroglycerin and women after it. The unexpected findings may be due to sex-specific pathophysiological differences. Keywords Tilt table testing · Vasovagal syncope · Nitroglycerin · Sex · Fainting Abbreviations BP Blood pressure HR Heart rate LUMC Leiden University Medical Centre Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10286-020-00666-5) contains supplementary material, which is available to authorized users. * Maryam Ghariq [email protected] 1
Department of Neurology, Leiden University Medical Centre, K5‑Q, PO Box 9600, 2300 RC Leiden, The Netherlands
2
Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
3
Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands
4
Department of Cardiovascular Medicine, University of Minnesota, Minneapolis, USA
NTG Nitroglycerin OR Odds ratio TLOC Transient loss of consciousness TTT Tilt table testing VVS Vasovagal syncope
Introduction Syncope is a form of transient loss of consciousness (TLOC) that is due to global self-terminating cerebral hypoperfusion; it is characterized by a rapid onset, short duration and a spontaneous
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