ISSN: 1223-1533

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EVALUATIONOF INFLUENCE OF MENSTRUAL CYCLE ON THE RESULTS OF HEAD-UP TILT TEST IN WOMEN WITH SUSPECTED VASOVAGAL SYNCOPE


Authors: Joanna Jedrzejczyk-Spaho, Artur Z. Pietrucha, Mateusz Wnuk, Irena Bzukala, Jadwiga Nessler, Marta Wegrynowska, Olga Kruszelnicka, Ewa Konduracka, Wieslawa Piwowarska




 

The aim of study: evaluation of influence of menstruation on frequency and type of vasovagal response to orthostatic stress during head-up tilt test (HUTT) in patients with vasovagal syncope (VVS).

 

Study population: among 850 consecutive patients with suspected VVS we observed a cohort of 500 women at age 13-79 yrs (median of age 37,5), referred to HUTT according to the ESC 2009 guidelines, was recruited.

Phase of menses period was described as phase II if covered last 14 days of menstruation cycle or phase I – when covered the period before phase II. According to results of HUTT the type of VVS, the duration of total HUTT and both passive and active phase were evaluated in relation to presence of menstruation and the phase of menses period.

 

Result: Among all studied women 315 pts were still menstruated (median of age 25 yrs; IQR 16-57): 170 (34.0%) in follicular, and 145 (29.0%) in luteal phase of the menstrual cycle whereas 185 (37.0%) underwent menopause (median of age 65 yrs; IQR 42-82); Mean age of first syncope was significantly lower in menstruated female in relation to those after menopause (median of age: 30 [IQR 14-56] vs 15 [IQR 10-21] yrs, p<0,0001) )

There was no difference between menstruating women in whom HUTT was performed at 1st and 2nd phase of menstruation cycle, regarding age of first syncope, number of syncope/presyncope episodes and CSSS results.

Vasodepressive VVS response was more frequently observed in women after menopause (29,9 vs 9,7%, p<0,0001), whereas cardioinhibitory (24,1 vs 9,0 %, p<0,0001) and mixed (45,7 vs 36,3%, p<0,001) responses were more frequent in menstruated ones.

Younger woman (age < median of age in whole group – 37,5 yrs) have similar distribution of type of VVS response during  HUTT  to  menstruated  ones,  whereas  type  of response  distribution  in  women  after  menopause  was parallel to older ones (> 37,5 ys)

 

Conclusions:

  1. Higher incidence of vasodepressive reaction in postmenopausal women in comparison to premenopausal women was noticed. Differences of type of vasovagal response during HUTT seems to be more relative to the age of women than the presence of menstruation.
  2. Age of first syncope presentation was significantly lower in menstruating women in relation to females after menopause – it may suggest different patomechanism of vasovagal syncope in these group of women (classical VVS or vasovagal disease).
  3. Menstrual phase does not influence on the tilt testing results, so the test can be easily performed despite of the phase of menstrual cycle.