Abstract
Background
Vasovagal syncope (VVS) occurs in > 40% of individuals at least once in their lifetime.
Sex-dependent differences in presentation and outcomes are not understood. We sought
to determine differences in clinical presentation, treatment modalities, and outcomes
of VVS between men and women.
Methods
Data were collected as part of the Prevention of Syncope Trials (POST) I and II, 2 multicenter, placebo-controlled, randomized trials testing
the effectiveness of metoprolol and fludrocortisone, respectively. Data regarding
clinical presentation, outcomes, and time to first syncope event after randomization
were compared.
Results
Of the 418 patients (280 women and 138 men), women were younger at the time of first
syncope event (21 vs 26 years P = 0.002) and had a lower baseline systolic blood pressure (117 vs 124 mm Hg, P < 0.001). Response to heat as a trigger for syncope was more common in women (68%
vs 48%, P = 0.011). Clinical presentation in women consisted more commonly of feeling warm, having
seizures, and experiencing more postsyncope fatigue (68% vs 54%, P = 0.048; 10% vs 2.7%, P = 0.045; 75% vs 59%, P = 0.017, respectively). Women were more likely to experience recurrent syncope after
adjustment for prerandomization syncope burden and randomization assignment (hazard
ratio, 1.56; 95% confidence interval, 1.10-2.22; P = 0.012).
Conclusion
Clinical presentation and provocative factors of VVS differ between men and women,
as do recurrent events. Recognition of these differences may help target therapy specifically
in men and women.
Résumé
Introduction
La syncope vasovagale (SVV) survient chez > 40 % des individus au moins 1 fois au
cours de leur vie. On ne comprend pas les différences sexuelles dans le tableau clinique
et les résultats cliniques. Nous avons cherché à déterminer les différences dans le
tableau clinique, les modalités de traitements et les résultats cliniques de la SVV
entre les hommes et les femmes.
Méthodes
Les données ont été recueillies dans le cadre des études POST (Prevention of Syncope Trials) I et II, 2 études multicentriques à répartition aléatoire contre placebo qui ont
testé de manière respective l’efficacité du métoprolol et de la fludrocortisone. Les
données concernant le tableau clinique, les résultats cliniques et le moment du premier
épisode de syncope après la randomisation ont fait l’objet d’une comparaison.
Résultats
Parmi les 418 patients (280 femmes et 138 hommes), les femmes étaient plus jeunes
au moment du premier épisode de syncope (21 ans vs 26 ans, P = 0,002) et avaient une pression systolique plus faible au début (117 mm Hg vs 124 mm Hg, P < 0,001). Le déclencheur le plus fréquent de la syncope chez les femmes (68 % vs 48 %, P = 0,011) était leur réponse à la chaleur. Le tableau clinique chez les femmes était
le plus souvent constitué par une sensation de chaleur, des crises et une plus grande
fatigue après la syncope (68 % vs 54 %, P = 0,048; 10 % vs 2,7 %, P = 0,045; 75 % vs 59 %, P = 0,017, respectivement). Les femmes étaient plus susceptibles de subir des syncopes
récurrentes après l’ajustement du fardeau de syncope avant la randomisation et l’assignation
aléatoire (ratio d’incidence approché, 1,56; intervalle de confiance à 95 %, 1,10-2,22;
P = 0,012).
Conclusion
Le tableau clinique et les facteurs déclenchants de la SVV diffèrent entre les hommes
et les femmes, tout comme les épisodes récurrents. La reconnaissance de ces différences
peut contribuer à la détermination du traitement indiqué chez les hommes et les femmes.
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Article info
Publication history
Published online: October 14, 2019
Accepted:
October 2,
2019
Received:
July 19,
2019
Footnotes
See page 83 for disclosure information.
Identification
Copyright
© 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
