Abstract:
OBJECTIVE:The natural history of pediatric patients with severely symptomatic neurocardiogenic syncope is poorly defined respect to the likelihood of remission or symptomatic recurrence along time. We undertook this study to investigate the likelihood of clinical relapse, and to assess the effect of prophylactic pharmacological treatment in the most symptomatic patients. METHODS:Twenty-nine patients with neurocardiogenic syncope were studied at our Institution: 14 (12 +/- 3.6 years) highly symptomatic received prophylactic therapy with beta-blockers guided by head up tilt (HUT), whereas 15 (12.2 +/- 2.7 years) moderately symptomatic received only education to avoid triggering of the vasovagal reflex and to abort forthcoming syncope. Patients were then followed respectively for 33.7 +/- 9.0 and 33.3 +/- 8.7 months (p = NS). RESULTS:The average duration of symptoms before HUT was 9.0 +/- 4.3 months (range 3-17) for treated patients, and 6.2 +/- 2.5 months (range 2-11) for those untreated (p < 0.05). Treated patients had also a greater number of symptomatic events: 6 +/- 2 vs. 2 +/- 1 (p < 0.001). During follow up, 9/15 untreated and 6/14 treated patients had at least 1 recurrence, with an odds ratio of 2 (95% CI 0.72-5.49). Clinical events were greatly reduced in both groups at follow up, but treated patients had a significantly greater reduction either of syncopal (p < 0.001) or near syncopal events (p < 0.02). Time to the first recurrence, syncope or near syncope, was shorter for untreated vs treated patients: 5 +/- 2 vs. 25 +/- 12 months (p < 0.001). Looking at the time course of all clinical recurrences, 23/26 occurred in untreated patients, whereas 7/10 occurred in treated patients within 24 months. An attempt to therapy discontinuation was made after 30 months in 4 patients, and resulted in half of them being asymptomatic, and half with a single minor recurrence. CONCLUSIONS:Spontaneous reduction of symptoms occurs along time in pediatric patients with neurocardiogenic syncope, so that recurrences are very unlikely after 24 months from first diagnosis. Tiered prophylactic therapy may be guided by HUT in selected highly symptomatic patients; beta-blockers appear a very effective intervention. Larger, prospective controlled studies are required to investigate the role of any intervention in moderately symptomatic patients.
journal_name
Cardiovasc Drugs Therjournal_title
Cardiovascular drugs and therapyauthors
Biffi M,Boriani G,Bronzetti G,Frabetti L,Picchio FM,Branzi Adoi
10.1023/a:1011179014084subject
Has Abstractpub_date
2001-03-01 00:00:00pages
161-7issue
2eissn
0920-3206issn
1573-7241journal_volume
15pub_type
杂志文章abstract::The pyrimidine base, orotic acid (OA), markedly improves the function of recently infarcted hearts subjected to global ischemia. The mechanism of cardiac action of OA is unclear, but it has been proposed that OA acts by correcting a relative deficiency of nucleotide precursors required for RNA synthesis in the stresse...
journal_title:Cardiovascular drugs and therapy
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journal_title:Cardiovascular drugs and therapy
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journal_title:Cardiovascular drugs and therapy
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abstract::We compared the time-course of the hemodynamic effect of isosorbide dinitrate (ISDN), 5 mg, in the form of sublingual tablet and oral spray, in 15 patients with isolated chronic pulmonary congestion (pulmonary arterial end-diastolic pressure of 15 mmHg or more in the presence of normal or only slightly reduced cardiac...
journal_title:Cardiovascular drugs and therapy
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abstract::In vitro and in vivo studies have demonstrated many similarities between the three calcium antagonists verapamil, nifedipine, and diltiazem in relation to protection of the myocardium during hypoxia. Important clinical differences exist between the three drugs when they are used during or after an acute myocardial inf...
journal_title:Cardiovascular drugs and therapy
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journal_title:Cardiovascular drugs and therapy
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journal_title:Cardiovascular drugs and therapy
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journal_title:Cardiovascular drugs and therapy
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
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doi:10.1007/s10557-007-6001-y
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journal_title:Cardiovascular drugs and therapy
pub_type: 临床试验,杂志文章,随机对照试验
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journal_title:Cardiovascular drugs and therapy
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journal_title:Cardiovascular drugs and therapy
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journal_title:Cardiovascular drugs and therapy
pub_type: 临床试验,杂志文章,随机对照试验
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