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Published online: 2018-09-13
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Predictors of syncope in patients with severe aortic stenosis: The role of orthostatic unload test

Paweł Kleczyński, Paweł Petkow Dimitrow, Artur Dziewierz, Agata Wiktorowicz, Tomasz Rakowski, Andrzej Surdacki, Dariusz Dudek
DOI: 10.5603/CJ.a2018.0107
·
Pubmed: 30234894

open access

Ahead of print
Original articles
Published online: 2018-09-13

Abstract

Background: There is a paucity of data regarding response of cerebral blood flow to the postural unloading maneuver and its impact on the risk of syncope in patients with aortic stenosis (AS). The aim of the present study was to assess effects of orthostatic stress test on changes in carotid and vertebral artery blood flow and its association with syncope in patients with severe AS.

Methods: 108 patients were enrolled (72 with and 36 patients without syncope) with severe isolated severe AS. Peak systolic blood-flow velocity (PSV) and end-diastolic velocity in the carotid arteries and vertebral arteries were measured by duplex ultrasound in the supine position and at 1–2 min after the assumption of the standing position.

Results: The orthostatic stress test induced a significant decrease in carotid and vertebral arterial flow velocities in all examined arteries (p < 0.001). The median (interquartile range) of mean change in PSV for carotid arteries was higher for patients with syncope (syncope [–] vs. syncope [+]: –0.6 cm/s [–1.8, 1.0] vs. –7.3 cm/s [–9.5, –2.0]; p < 0.001) and similarly for vertebral arteries: (–0.5 cm/s [–2.0, 0.5] vs. –4.8 cm/s [–6.5, –1.3]; p < 0.001, respectively). Age, aortic valve area, and mean change in PSV for carotid arteries were independently associated with syncope.

Conclusions: In patients with AS, a decrease in carotid and vertebral arterial flow velocities in the standing position was observed and was associated with syncope. The present findings may support the value of an orthostatic test in identifying patients with severe AS and a high risk of syncope.

Abstract

Background: There is a paucity of data regarding response of cerebral blood flow to the postural unloading maneuver and its impact on the risk of syncope in patients with aortic stenosis (AS). The aim of the present study was to assess effects of orthostatic stress test on changes in carotid and vertebral artery blood flow and its association with syncope in patients with severe AS.

Methods: 108 patients were enrolled (72 with and 36 patients without syncope) with severe isolated severe AS. Peak systolic blood-flow velocity (PSV) and end-diastolic velocity in the carotid arteries and vertebral arteries were measured by duplex ultrasound in the supine position and at 1–2 min after the assumption of the standing position.

Results: The orthostatic stress test induced a significant decrease in carotid and vertebral arterial flow velocities in all examined arteries (p < 0.001). The median (interquartile range) of mean change in PSV for carotid arteries was higher for patients with syncope (syncope [–] vs. syncope [+]: –0.6 cm/s [–1.8, 1.0] vs. –7.3 cm/s [–9.5, –2.0]; p < 0.001) and similarly for vertebral arteries: (–0.5 cm/s [–2.0, 0.5] vs. –4.8 cm/s [–6.5, –1.3]; p < 0.001, respectively). Age, aortic valve area, and mean change in PSV for carotid arteries were independently associated with syncope.

Conclusions: In patients with AS, a decrease in carotid and vertebral arterial flow velocities in the standing position was observed and was associated with syncope. The present findings may support the value of an orthostatic test in identifying patients with severe AS and a high risk of syncope.

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Keywords

aortic stenosis, syncope, orthostatic stress, Doppler ultrasound, cerebral blood flow

About this article
Title

Predictors of syncope in patients with severe aortic stenosis: The role of orthostatic unload test

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Original Article

Published online

2018-09-13

DOI

10.5603/CJ.a2018.0107

Pubmed

30234894

Keywords

aortic stenosis
syncope
orthostatic stress
Doppler ultrasound
cerebral blood flow

Authors

Paweł Kleczyński
Paweł Petkow Dimitrow
Artur Dziewierz
Agata Wiktorowicz
Tomasz Rakowski
Andrzej Surdacki
Dariusz Dudek

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