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

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

doi:10.36660/ijcs.20230017

Acessibilidade / Reportar erro

Brasil

International Journal of Cardiovascular Sciences

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • Int J Cardiovasc Sci 37 • 2024 • https://doi.org/10.36660/ijcs.20230017 copy

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

Authorship SCIMAGO INSTITUTIONS RANKINGS

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.

Keywords:
Syncope; Quality of Life; Physical Examination

Variable	Values
Age (mean ± SD)	43.7 ± 20.8
Female sex (%)	56.1
Calgary score (median; interquartile range)	1.0; −2.0;1.75
Sensitized HUTT (%)	69.5
Time of symptom onset > 3 months (%)	58.5
Presence of prodromes (%)	85.3
Patients with prior recurrent events (%)	69
Number of events before the HUTT (mean ± SD)	3.17 ± 1.5
Trauma resulting from syncope (%)	40.2

Questionnaire	Domains	Score^* * mean ± SD
SF-36	Functional capacity	86.8±20.0
	Physical aspects	77.1±38.3
	Pain	38.6±19.8
	Mental aspects	75.5±16.6
	Vitality	61.7 ±18.8
	Social aspects	80.9±18.9
	General health status	75.4±19.3
	Emotional aspects	82.1±35.2
ISQL	1- In the last month, as a result of fainting, how often have you:
	a- felt tired and worn out?	3.6±1.2
	b- felt frustrated?	4.2±1.1
	c- felt limited in the type of work you do?	4.1±1.1
	d- worried about fainting again?	3.4±1.3
	e- felt frightened of fainting?	3.4±1.3
	f- noticed that fainting interfered with vigorous physical activities?	3.7±1.3
	2- In the last month, to what extent do you agree that:
	a- you have accomplished less than you would like to?	3.4±1.6
	b- other people have noticed the effect of fainting on your life?	3.4±1.5
	c- fainting left you feeling confused?	3.9±1.4
	3- In the last month, how often have you avoided:
	a- driving a vehicle?	4.9±1.6
	b- standing for longer than 5 minutes?	5.1±1.1
	c- being in warm/hot environments due to the fear of fainting?	4.8±1.3

QoL questionnaire	Subitem of the questionnaire	Sex		p value	Prodromes		p value	Trauma		p value	HUTT phase		p value
QoL questionnaire	Subitem of the questionnaire	M	F	p value	No	Yes	p value	No	Yes	p value	NSE	SE	p value
SF-36	FC	91.8	82.9	0.04^* * p < 0.05.	80.8	87.9	0.26	92.7	78.0	0.001^* * p < 0.05.	95.0	83.2	0.01^* * p < 0.05.
	PA	86.1	70.1	0.06	66.8	78.9	0.31	82.6	68.9	0.11	89.0	71.9	0.06
	Pain	88.1	83.7	0.32	87.9	72.0	0.009^* * p < 0.05.	90.9	77.7	0.003^* * p < 0.05.	91.1	83.2	0.09
	GHS	76.4	74.7	0.68	75.5	75.4	0.09	78.9	70.3	0.04^* * p < 0.05.	80.1	73.1	0.09
	SA	83.3	79.1	0.32	79.2	81.3	0.72	84.4	75.7	0.04^* * p < 0.05.	84.0	79.6	0.33
	MA	75.1	70.6	0.22	77.3	71.8	0.29	74.4	69.9	0.24	72.2	72.7	0.87
	Vitality	65.5	58.8	0.10	67.5	60.8	0.26	64.6	57.6	0.09	65.2	60.3	0.27
	EA	89.8	76.1	0.08	72.2	83.8	0.29	85.0	77.8	0.36	86.7	80.1	0.44
ISQL	Total	52.2	44.8	0.02^* * p < 0.05.	47.2	48.2	0.78	50.3	44.6	0.02^* * p < 0.05.	49.6	47.2	0.41

Variable	CI response	VD response	p value
Patients (n)	46	36	0.117
Age (years)^* * mean ± SD	30.0 ± 12.9	61.2 ± 15.1	0.002
Male/female sex (n)	24/22	12/24	0.08
Onset of events (months)^* * mean ± SD	3.5 ± 1.9	2.6 ± 1.9	0.05
Total events^* * mean ± SD	2.9 ± 1.4	2.6 ± 1.8	0.004
Calgary score (points)^* * mean ± SD	1.6 ± 2.2	-1.8 ± 2.3	0.001
Time to event on HUTT (minutes)	20.5 ± 9.0	24.3 ± 7.1	0.04
Patients with recurrence after HUTT	26	10	0.009

Questionnaire	CI response^* * mean ± SD; ISQL: Impact of Syncope on Quality of Life	VD response^* * mean ± SD; ISQL: Impact of Syncope on Quality of Life	p value
SF-36 Functional capacity Physical aspects Pain General health status Social aspects Mental aspects Vitality Emotional aspects	96.2 ± 9.7	74.8 ± 23.2	<0.0001
	90.7 ± 28.5	59.7 ± 42.3	<0.0001
	95.0 ± 9.5	73.5 ± 22.8	<0.0001
	82.3 ± 15.2	66.7 ± 20.5	<0.0001
	85.8 ± 14.8	74.6 ± 21.8	0.007
	75.2 ± 14	69.2 ± 19	0.106
	67.2 ± 5.1	54.7±21	0.002
	94.2 ± 21.4	66.6 ± 7.1	<0.0001
ISQL ^† † points converted to a scale from 0 to 100.	52.4 ± 8.6	42.5 ± 11.2	<0.0001

Sociedade Brasileira de Cardiologia Avenida Marechal Câmara, 160, sala: 330, Centro, CEP: 20020-907, (21) 3478-2700 - Rio de Janeiro - RJ - Brazil
E-mail: revistaijcs@cardiol.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Mailing Address: Claudia Madeira Miranda Hospital Madre Teresa. Av Raja Gabaglia, 1002. Postal code: 30441-070. Belo Horizonte, MG – Brazil E-mail: clmmiranda@hotmail.com