Aetiology and haemodynamic patterns of orthostatic hypotension in a tertiary syncope unit

• DOI: 10.1093/europace/euaf017
• Publication Date: 2025-01-17T08:35:22Z
• Authors: Madeleine Johansson; Boriana S Gagaouzova; Ineke A van Rossum; Roland D Thijs; Viktor Hamrefors; J Gert van Dijk; Artur Fedorowski
• Keywords: Etiology

Abstract Background Orthostatic hypotension (OH) is an important differential diagnosis in unexplained syncope. Neurogenic OH (nOH) has been postulated to differ from non-neurogenic (non-nOH), yet pathophysiological differences are largely unexplored. We aimed investigate etiology and tilt table test (TTT)-induced hemodynamic responses symptomatic patients. Methods performed a retrospective study analyzing patients referred for syncope or highly orthostatic intolerance with TTT-verified classical (cOH). Medical records were analyzed the presumptive of cOH. Fifty-two (mean age 73±9 years, 46% women) good quality TTT recordings divided into three groups on clinical grounds: nOH, non-nOH, mixed OH. The log-ratio (LR) method was applied compare decrease mean arterial pressure (MAPLR) corresponding contributions heart rate (HRLR), stroke volume (SVLR) total peripheral resistance (TPRLR) during upright phase TTT. Results prevalence cOH 12 (23%) 14 (27%) non-nOH 26 (50%) No difference MAPLR observed among 4th minute (nOH: -0.10±0.04 vs. non-nOH: -0.07±0.05 OH: -0.06±0.05, p=0.10). HRLR, SVLR TPRLR drop did not between (all p>0.05). Conclusions One-half had OH, whereas one-quarter either pure neurogenic, respectively. Different forms indifferentiable based TTT, questioning utility such classification. Larger studies needed confirm these findings.