Syncope without prodromes in patients with normal heart and normal electrocardiogram: a distinct entity.

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Syncope without prodromes in patients with normal heart and normal electrocardiogram: a distinct entity.

J Am Coll Cardiol. 2013 Jun 26;

Authors: Deharo JC, Guieu R, Mechulan A, Peyrouse E, Kipson N, Ruf J, Gerolami V, Devoto G, Marrè V, Brignole M

Abstract
OBJECTIVES: We investigated the clinical and laboratory findings of patients affected by sudden-onset syncope without prodromes who had a normal heart and normal electrocardiogram.
BACKGROUND: The pathophysiology of syncope in these patients is uncertain.
METHODS: We compared the clinical and laboratory findings of 15 patients with sudden-onset syncope without prodromes, a normal heart and normal electrocardiogram with those of 31 patients affected by established vasovagal syncope (VVS).
RESULTS: The study group patients were older than VVS patients (61±12 vs. 46±17 years) and had a history of fewer episodes of syncope (median 2 [IQR 1-2.5] vs 9 [4-15]), which were of more recent onset (median 1 [IQR 0-1] vs. 10.5 [IQR 3.3-27] years). The study group had lower median baseline plasmatic adenosine values than the VVS group (0.25 μM [95% CI 0.10 - 1.51] vs. 0.85 μM [95% CI 0.32 - 2.80]). On ROC curve analysis, the plasmatic adenosine value of ≤0.36 best discriminated between groups, displaying 73% sensitivity and 93% specificity. Tilt table testing was more frequently positive in VVS than in the study group (74% vs. 33%). A similarly high positivity rate of Adenosine/ATP testing was found in both groups.
CONCLUSIONS: Common clinical features and low plasmatic adenosine values define a distinct form of syncope, distinguish it from VVS and suggest a causal role of the adenosine pathway.

PMID: 23810895 [PubMed - as supplied by publisher]

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