3901de271f7d8a6d083364232337f32d ehae907.pdf e9ee98e16114a633cf3a82f14d7ffb24b9685576 ehae907.pdf d28930e62eb0c49eaf2a6d29d8379ddc71169691de316478092f3efe033604fb ehae907.pdf Title: Mechanism of syncope: role of ambulatory blood pressure monitoring and cardiovascular autonomic function assessment Subject: DOI: 10.1093/eurheartj/ehae907; European Heart Journal, 46, 9, 2024-12-30.; Abstract: Background and Aims: Identifying the haemodynamic mechanism of autonomic syncope is the essential pre-requisite for effective and personalized therapy aimed at preventing recurrences. The present study assessed the diagnostic efficacy of a two-step assessment. Methods: Multicentre prospective, cross-sectional, observational study. Patients affected by severe autonomic syncope underwent a two-step assessment including 24-h ambulatory blood pressure monitoring and short cardiovascular autonomic function assessment (SCAFA). SCAFA consisted of carotid sinus massage (CSM), performed in patients ≥40 years old, a passive standing test, and a ‘fast’ head-up tilt test scheduled sequentially during one session on a tilt table. Results: The study population consisted of 333 patients, 102 ≤ 40 years old and 231 > 40 years old. Any positive response was observed in 298 (89%) patients (92 [92%] in younger and 13 Keywords: Syncope; Reflex syncope; Blood pressure; Hypotension; Bradycardia; Ambulatory blood pressure monitoring; Carotid sinus massage; Tilt testing; Standing test Author: Antonella Groppelli Creator: Servigistics Arbortext Advanced Print Publisher 11.1.4546/W-x64 Producer: PDFlib+PDI 9.0.7p3 (C++/Win64) CreationDate: Tue Feb 25 14:16:02 2025 CET ModDate: Wed Feb 26 15:38:10 2025 CET Custom Metadata: yes Metadata Stream: yes Tagged: yes UserProperties: no Suspects: no Form: none JavaScript: no Pages: 9 Encrypted: no Page size: 595.276 x 793.701 pts Page rot: 0 File size: 954262 bytes Optimized: no PDF version: 1.6 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- GMXKDD+GillSansNova-Book CID TrueType Identity-H yes yes yes 1223 0 NRJTJU+GillSansNova-Bold CID TrueType Identity-H yes yes yes 1228 0 ISOUWF+GillSansNova-BookItalic CID TrueType Identity-H yes yes yes 1233 0 MBZTAM+GillSansNova-Heavy CID TrueType Identity-H yes yes yes 1238 0 IMIQWT+STIXGeneral-Regular Type 1C Custom yes yes yes 1243 0 OTPSHQ+GillSansNova-Medium CID TrueType Identity-H yes yes yes 14 0 SNGZIS+GillSansNova-Book Type 1C Custom yes yes yes 22 0 SNGZIS+GillSansNova-Bold Type 1C WinAnsi yes yes yes 27 0 SNGZIS+GillSansNova-Medium Type 1C Custom yes yes no 31 0 SNGZIS+GillSansNova-Book Type 1C Custom yes yes no 35 0 YQDVLV+MeiryoUI CID TrueType Identity-H yes yes yes 236 0 LTFUXH+GillSansNova-BoldItalic CID TrueType Identity-H yes yes yes 318 0 NVILNB+STIXGeneral-Bold Type 1C Custom yes yes yes 323 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2026-03-14 04:19:24 CET RepresentationInformation: ehae907.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2026-03-13 14:26:42 CET Size: 954262 Format: PDF Version: 1.6 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf Profile: Tagged PDF PDFMetadata: Objects: 1319 FreeObjects: 4 IncrementalUpdates: 4 DocumentCatalog: ViewerPreferences: HideToolbar: false HideMenubar: false HideWindowUI: false FitWindow: false CenterWindow: false DisplayDocTitle: true NonFullScreenPageMode: UseNone Direction: L2R ViewArea: CropBox ViewClip: CropBox PrintArea: CropBox PageClip: CropBox PageLayout: OneColumn PageMode: UseOutlines Language: en Outlines: Item: Title: Mechanism of syncope: role of ambulatory blood pressure monitoring and cardiovascular autonomic function assessment Destination: head1 Children: Item: Title: Introduction Destination: secehae907-s1 Item: Title: Methods Destination: secehae907-s2 Children: Item: Title: Inclusion criteria Destination: secehae907-s2.1 Item: Title: Exclusion criteria Destination: secehae907-s2.2 Item: Title: 2STEPs tests: method and positivity criteria Destination: secehae907-s2.3 Children: Item: Title: Ambulatory blood pressure monitoring Destination: secehae907-s2.3.1 Item: Title: Short cardiovascular autonomic function assessment Destination: secehae907-s2.3.2 Item: Title: Endpoints Destination: secehae907-s2.4 Children: Item: Title: Primary endpoint Destination: secehae907-s2.4.1 Item: Title: Secondary endpoints Destination: secehae907-s2.4.2 Item: Title: Statistical analysis Destination: secehae907-s2.5 Item: Title: Results Destination: secehae907-s3 Children: Item: Title: Endpoints Destination: secehae907-s3.1 Item: Title: Inter-centre variability of carotid sinus massage Destination: secehae907-s3.2 Item: Title: Discussion Destination: secehae907-s4 Children: Item: Title: Limitations Destination: secehae907-s4.1 Item: Title: Practical implications Destination: secehae907-s4.2 Item: Title: Conclusion Destination: secehae907-s5 Item: Title: Supplementary data Destination: secehae907-s6 Item: Title: Declarations Destination: secehae907-s7 Children: Item: Title: Disclosure of Interest Destination: secehae907-s7.1 Item: Title: Data Availability Destination: secehae907-s7.2 Item: Title: Funding Destination: secehae907-s7.3 Item: Title: Ethical Approval Destination: secehae907-s7.4 Item: Title: Pre-registered Clinical Trial Number Destination: secehae907-s7.14 Item: Title: References Destination: reflist Info: Title: Mechanism of syncope: role of ambulatory blood pressure monitoring and cardiovascular autonomic function assessment Author: Antonella Groppelli Subject: DOI: 10.1093/eurheartj/ehae907; European Heart Journal, 46, 9, 2024-12-30.; Abstract: Background and Aims: Identifying the haemodynamic mechanism of autonomic syncope is the essential pre-requisite for effective and personalized therapy aimed at prevent椀渀最 爀攀挀甀爀爀攀渀挀攀猀⸀ 吀栀攀 瀀爀攀猀攀渀琀 猀琀甀搀礀 愀猀猀攀猀猀攀搀 琀栀攀 搀椀愀最渀漀猀琀椀挀 攀昀昀椀挀愀挀礀 漀昀 愀 琀眀漀ⴀ猀琀攀瀀 愀猀猀攀猀猀洀攀渀琀⸀ 䴀攀琀栀漀搀猀㨀 䴀甀氀琀椀挀攀渀琀爀攀 瀀爀漀猀瀀攀挀琀椀瘀攀Ⰰcross-sectional, observational study. Patients affected by severe autonomic syncope underwent a two-step assessment including 2㐀ⴀ栀 愀洀戀甀氀愀琀漀爀礀 戀氀漀漀搀 瀀爀攀猀猀甀爀攀 洀漀渀椀琀漀爀椀渀最 愀渀搀 猀栀漀爀琀 挀愀爀搀椀漀瘀愀猀挀甀氀愀爀 愀甀琀漀渀漀洀椀挀 昀甀渀挀琀椀漀渀 愀猀猀攀猀猀洀攀渀琀 匀䌀䄀䘀䄀⸀ 匀䌀䄀䘀䄀 挀漀渀猀椀猀琀攀搀 漀昀 挀愀otid sinus massage (CSM), performed in patients ≥40 years old, a passive standing test, and a ‘fast’ head-up tilt test schedul攀搀 猀攀焀甀攀渀琀椀愀氀氀礀 搀甀爀椀渀最 漀渀攀 猀攀猀猀椀漀渀 漀渀 愀 琀椀氀琀 琀愀戀氀攀⸀ 刀攀猀甀氀琀猀㨀 吀栀攀 猀琀甀搀礀 瀀漀瀀甀氀愀琀椀漀渀 挀漀渀猀椀猀琀攀搀 漀昀 ㌀㌀㌀ 瀀愀琀椀攀渀琀猀Ⰰ ㄀　㈠ढ搠ऀ㐀　 礀攀愀爀猀 漀氀搀and 231 > 40 years old. 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The present study assessed the diagnostic efficacy of a two-step assessment. Methods: Multicentre prospective, cross-sectional, observational study. Patients affected by severe autonomic syncope underwent a two-step assessment including 24-h ambulatory blood pressure monitoring and short cardiovascular autonomic function assessment (SCAFA). SCAFA consisted of carotid sinus massage (CSM), performed in patients ≥40 years old, a passive standing test, and a ‘fast’ head-up tilt test scheduled sequentially during one session on a tilt table. Results: The study population consisted of 333 patients, 102 ≤ 40 years old and 231 > 40 years old. Any positive response was observed in 298 (89%) patients (92 [92%] in younger and 13 © The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. Syncope Reflex syncope Blood pressure Hypotension Bradycardia Ambulatory blood pressure monitoring Carotid sinus massage Tilt testing Standing test Journal European Heart Journal © The Author(s) 2024. 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