Author/Editor		Šinkovec, Matjaž; Grad, Anton; Rakovec, Peter
Title		Role of endogenous adenosine in vasovagal syncope
Type		članek
Source		Clin Auton Res
Vol. and No.		Letnik 11
Publication year		2001
Volume		str. 155-61
Language		eng
Abstract		Adenosine may be a potential mediator in the pathogenesis of vasovagal syncope. Intravenous adenosine increases sympathetic discharge and provokes vasovagal syncope in sensitive subjects. No data are available for endogenous adenosine. The authors compared the results of head-up tilt-table testing (HUT) (45 minutes at 60 degrees) of three arbitrary groups of subjects: sensitive (n = 25, age 34 y, vasovagal syncope, positive HUT), moderately sensitive (n = 28, age 34 y, vasovagal syncope, negative HUT), and nonsensitive (n = 19, age 30 y). A positive test result produced syncopal symptoms with hypotension and/or bradycardia. Single-lead electrocardiogram (ECG) was recorder, and arterial pressure was measured noninvasively. Fourier transform was used for power-spectral heart rate variability (HRV) analysis of 5-minute ECG data. In the nonsensitive and moderately sensitive groups, HUT was repeated with intravenous dipyridamole, an adenosine transport blocker. In the sensitive group, HUT was repeated with oral theophylline, an adenosine receptor blocker, or placebo. In the moderately sensitive group, a third HUT was performed with dipyridamole and oral theophylline. If adenosine plays a role in vasovagal syncope, then dipyridamole would induce more positive HUT responses, a positive HUT response would be prevented by theophylline, and hemodynamic and HRV data in positive HUT responses induced by dipyridamole should reproduce those observed during spontaneous positive HUT responses. Dipyridamole induced positive HUT responses in 57% of the moderately sensitive group and 21% of the nonsensitive group (p<0.05). Theophylline treatment was not efficient in preventing HUT-induced syncope in sensitive subjects; however, it prevented dipyridamole-induced syncope in 75% of the moderately sensitive group. Dipyridamole immediately increased arterial pressure, heart rate, and total HRV in all (p<0.05). (Abstract truncated at 2000 characters).
Descriptors		SYNCOPE, VASOVAGAL DIPYRIDAMOLE THEOPHYLLINE TILT-TABLE TEST ADULT ELECTROCARDIOGRAPHY BLOOD PRESSURE HEART RATE ADENOSINE FOURIER ANALYSIS