CURRENT ACHIEVEMENTS IN THE PATHOPHYSIOLOGY MECHANISMS UNDERSTANDING OF SYNCOPE DEVELOPMENT IN CHILDREN
DOI:
https://doi.org/10.11603/24116-4944.2023.1.13934Keywords:
vasovagal syncope, syncope due to orthostatic hypotension, cardiogenic syncope, etiology, pathophysiological mechanisms, childrenAbstract
The aim of the study – to analyze modern scientific achievements in the field of pathophysiological mechanisms of the syncope development.
Materials and Methods. PubMed Medline and Scopus databases were used to search for scientific studies using the search terms "syncope" and "etiology"; "syncope" and "pathophysiology"; "syncope" and "mechanisms of development". 76 full-text English articles published between January 2013 and December 2022 were included in this literature review.
Results and Discussion. Although the reasons for hemodynamic differences between patients with syncope and the general population remain unknown, probable mechanisms of noncardiogenic syncope development in the form of a decrease in the blood circulating volume, an increase in venous filling, and abnormal neuroendocrine activation have been described. The current scientific understanding of the role of the pathological Bezold-Jarisch reflex in the development of syncope is considered. Attention is drawn to new concepts – “hypotensive phenotype”, which indicates susceptibility to the development of vasovagal syncope and "susceptibility to hypotension " in the context of the response to the tilt test. The mechanisms of the formation of vasodepression and cardioinhibition during passive orthostasis and their role in the pathogenesis of syncope are described. Evidence is presented for a wide range of neurohumoral changes associated with the development of syncope. A separate role is assigned to paradoxical peripheral vasodilatation, which can initiate inappropriate arterial hypotension during syncope. A number of facts are described, which are proof of the genetic basis of the fainting development. The further research is needed for a better understanding of all possible pathogenetic mechanisms of syncope, which will allow to improve the effectiveness of treatment and prevention measures, taking into account the pathophysiological features of each individual type of fainting.
Conclusions. The results of the literature review provide grounds for asserting that many factors, such as the abnormal Bezold-Jarisch reflex, dysfunction of the autonomic nervous system, neurohumoral factors, etc., to some extent explain the mechanisms of syncope development and leave a window of opportunity in the search for new effective methods of treatment and prevention of syncope in children.
References
Brignole, M., Moya, A., de Lange, F.J., Deharo, J.C., Elliott, P.M., Fanciulli, A., … ESC Scientific Document Group (2018). 2018 ESC Guidelines for the diagnosis and management of syncope. European Heart Journal, 39(21), 1883-1948. DOI: 10.1093/eurheartj/ehy037. DOI: https://doi.org/10.1093/eurheartj/ehy210
Silva, M., Godinho, A., & Freitas, J. (2016). Transient loss of consciousness assessment in a University Hospital: From diagnosis to prognosis. Porto Biomedical Journal, 1(3), 118-123. DOI: 10.1016/j.pbj.2016.07.001. DOI: https://doi.org/10.1016/j.pbj.2016.07.001
Villafane, J., Miller, J.R., Glickstein, J., Johnson, J.N., Wagner, J., Snyder, C.S., … Chowdhury, D. (2021). Loss of Consciousness in the Young Child. Pediatric Cardiology, 42(2), 234-254. DOI: 10.1007/s00246-020-02498-6.
Bassetti, C.L. (2014). Transient loss of consciousness and syncope. Handbook of Clinical Neurology, 119, 169-191. DOI: 10.1016/B978-0-7020-4086-3.00013-8. DOI: https://doi.org/10.1016/B978-0-7020-4086-3.00013-8
Shen, W.K., Sheldon, R.S., Benditt, D.G., Cohen, M., Forman, D.E., Goldberger, Z.D., … Yancy, C.W. (2017). 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology /American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation, 136(5), e60-e122. DOI: 10.1161/CIR.0000000000000499. DOI: https://doi.org/10.1161/CIR.0000000000000537
Li, H., Liao, Y., Han, Z., Wang, Y., Liu, P., Zhang, C., … Jin, H. (2018). Head-up tilt test provokes dynamic alterations in total peripheral resistance and cardiac output in children with vasovagal syncope. Acta Paediatrica, 107(10), 1786-1791. DOI: 10.1111/apa.14342. DOI: https://doi.org/10.1111/apa.14342
Li, H.X., Gao, L., & Yuan, Y. (2021). Advance in the understanding of vasovagal syncope in children and adolescents. World Journal of Pediatrics:WJP, 17(1), 58-62. DOI: 10.1007/s12519-020-00367-z. DOI: https://doi.org/10.1007/s12519-020-00367-z
Magkas, N., Tsioufis, C., Thomopoulos, C., Dilaveris, P., Georgiopoulos, G., Sanidas, E., Papademetriou, V., & Tousoulis, D. (2019). Orthostatic hypotension: From pathophysiology to clinical applications and therapeutic considerations. Journal of Clinical Hypertension (Greenwich, Conn.), 21(5), 546-554. DOI: 10.1111/jch.13521. DOI: https://doi.org/10.1111/jch.13521
He, W., Wang, X., Liu, S., Yu, X., Lu, Z., Ma, R., … Jiang, H. (2018). Sympathetic mechanisms in an animal model of vasovagal syncope. Clinical Autonomic Research : official journal of the Clinical Autonomic Research Society, 28(3), 333-340. DOI: 10.1007/s10286-018-0503-5. DOI: https://doi.org/10.1007/s10286-018-0503-5
Olshansky, B., Cannom, D., Fedorowski, A., Stewart, J., Gibbons, C., Sutton, R., & Benditt, D.G. (2020). Postural Orthostatic Tachycardia Syndrome (POTS): A critical assessment. Progress in Cardiovascular Diseases, 63(3), 263-270. DOI: 10.1016/j.pcad.2020.03.010. DOI: https://doi.org/10.1016/j.pcad.2020.03.010
Stewart, J.M., Medow, M.S., Sutton, R., Visintainer, P., Jardine, D.L., & Wieling, W. (2017). Mechanisms of Vasovagal Syncope in the Young: Reduced Systemic Vascular Resistance Versus Reduced Cardiac Output. Journal of the American Heart Association, 6(1). DOI: 10.1161/JAHA.116.004417. DOI: https://doi.org/10.1161/JAHA.116.004417
Gopinathannair, R., Salgado, B.C., & Olshansky, B. (2018). Pacing for Vasovagal Syncope. Arrhythmia & Electrophysiology Review, 7(2), 95-102. DOI:10.15420/aer.2018.22.2. DOI: https://doi.org/10.15420/aer.2018.22.2
Brignole, M., Rivasi, G., Sutton, R., Kenny, R.A., Morillo, C.A., Sheldon, R., … Fedorowski, A. (2021). Low-blood pressure phenotype underpins the tendency to reflex syncope. Journal of Hypertension, 39(7), 1319-1325. DOI: 10.1097/HJH.0000000000002800. DOI: https://doi.org/10.1097/HJH.0000000000002800
Rivasi, G., Ungar, A., Moya, A., Brignole, M., Sutton, R., & Fedorowski, A. (2021). Syncope: new solutions for an old problem. Kardiologia Polska, 79(10), 1068-1078. DOI: 10.33963/KP.a2021.0138. DOI: https://doi.org/10.33963/KP.a2021.0138
Nilsson, D., Sutton, R., Tas, W., Burri, P., Melander, O., & Fedorowski, A. (2015). Orthostatic Changes in Hemodynamics and Cardiovascular Biomarkers in Dysautonomic Patients. PloS One, 10(6). DOI: 10.1371/journal.pone.0128962. DOI: https://doi.org/10.1371/journal.pone.0128962
Lindenberger, M., & Länne, T. (2015). Slower lower limb blood pooling in young women with orthostatic intolerance. Experimental Physiology, 100(1), 2-11. DOI: 10.1113/expphysiol.2014.082867. DOI: https://doi.org/10.1113/expphysiol.2014.082867
Skoog, J., Lindenberger, M., Ekman, M., Holmberg, B., Zachrisson, H., & Länne, T. (2016). Reduced venous compliance: an important determinant for orthostatic intolerance in women with vasovagal syncope. American Journal of Physiology. Regulatory, Integrative and Comparative Physiology, 310(3), R253-R261. DOI: 10.1152/ajpregu.00362.2015. DOI: https://doi.org/10.1152/ajpregu.00362.2015
Sutton, R., & Brignole, M. (2014). Twenty-eight years of research permit reinterpretation of tilt-testing: hypotensive susceptibility rather than diagnosis. European Heart Journal, 35(33), 2211-2212. DOI: 10.1093/eurheartj/ehu255. DOI: https://doi.org/10.1093/eurheartj/ehu255
Kulkarni, N., Mody, P., & Levine, B.D. (2020). Abolish the Tilt Table Test for the Workup of Syncope! Circulation, 141(5), 335-337. DOI: 10.1161/CIRCULATIONAHA.119.043259. DOI: https://doi.org/10.1161/CIRCULATIONAHA.119.043259
Thijs, R.D., Brignole, M., Falup-Pecurariu, C., Fanciulli, A., Freeman, R., Guaraldi, P., … Van Dijk, J.G. (2021). Recommendations for tilt table testing and other provocative cardiovascular autonomic tests in conditions that may cause transient loss of consciousness : Consensus statement of the European Federation of Autonomic Societies (EFAS) endorsed by the American Autonomic Society (AAS) and the European Academy of Neurology (EAN). Clinical Autonomic Research : official journal of the Clinical Autonomic Research Society, 31(3), 369-384. DOI: 10.1007/s10286-020-00738-6. DOI: https://doi.org/10.1007/s10286-020-00738-6
Fedorowski, A., Rivasi, G., Torabi, P., Johansson, M., Rafanelli, M., & Parati, G. (2021). Underlying hemodynamic differences are associated with responses to tilt testing. Scientific Reports, 11(1), 17894. DOI: 10.1038/s41598-021-97503-0. DOI: https://doi.org/10.1038/s41598-021-97503-0
Wieling, W., Jardine, D.L., de Lange, F.J., Brignole, M., Nielsen, H. B., Stewart, J., & Sutton, R. (2016). Cardiac output and vasodilation in the vasovagal response: An analysis of the classic papers. Heart Rhythm, 13(3), 798-805. DOI: 10.1016/j.hrthm.2015.11.023. DOI: https://doi.org/10.1016/j.hrthm.2015.11.023
van Dijk, J.G., Ghariq, M., Kerkhof, F.I., Reijntjes, R., van Houwelingen, M.J., van Rossum, I.A., …, Benditt, D.G. (2020). Novel Methods for Quantification of Vasodepression and Cardioinhibition During Tilt-Induced Vasovagal Syncope. Circulation Research, 127(5), e126-e138. DOI: 10.1161/CIRCRESAHA.120.316662. DOI: https://doi.org/10.1161/CIRCRESAHA.120.316662
Jardine, D.L., Wieling, W., Brignole, M., Lenders, J.W.M., Sutton, R., & Stewart, J. (2018). The pathophysiology of the vasovagal response. Heart Rhythm, 15(6), 921-929. DOI: 10.1016/j.hrthm.2017.12.013. DOI: https://doi.org/10.1016/j.hrthm.2017.12.013
Schwartz, C.E., Lambert, E., Medow, M.S., & Stewart, J.M. (2013). Disruption of phase synchronization between blood pressure and muscle sympathetic nerve activity in postural vasovagal syncope. American journal of physiology. Heart and Circulatory Physiology, 305(8), H1238-H1245. DOI: 10.1152/ajpheart.00415.2013. DOI: https://doi.org/10.1152/ajpheart.00415.2013
Fu, Q., Verheyden, B., Wieling, W., & Levine, B.D. (2012). Cardiac output and sympathetic vasoconstrictor responses during upright tilt to presyncope in healthy humans. The Journal of Physiology, 590(8), 1839-1848. DOI: 10.1113/jphysiol.2011.224998. DOI: https://doi.org/10.1113/jphysiol.2011.224998
Guo, Y., Chen, X., Zeng, T., Wang, L., & Cen, L. (2021). Age Is a Predictor for the Syncope Recurrence in Elderly Vasovagal Syncope Patients With a Positive Head-Up Tilt Test. Frontiers in Cardiovascular Medicine, 8. DOI: 10.3389/fcvm.2021.667171. DOI: https://doi.org/10.3389/fcvm.2021.667171
Brignole, M., & Rivasi, G. (2021). New insights in diagnostics and therapies in syncope: a novel approach to non-cardiac syncope. Heart (British Cardiac Society), 107(11), 864-873. DOI: 10.1136/heartjnl-2020-318261. DOI: https://doi.org/10.1136/heartjnl-2020-318261
Freeman, R., Abuzinadah, A.R., Gibbons, C., Jones, P., Miglis, M.G., & Sinn, D.I. (2018). Orthostatic Hypotension: JACC State-of-the-Art Review. Journal of the American College of Cardiology, 72(11), 1294-1309. DOI: 10.1016/j.jacc.2018.05.079. DOI: https://doi.org/10.1016/j.jacc.2018.05.079
Fedorowski, A., van Wijnen, V.K., & Wieling, W. (2017). Delayed orthostatic hypotension and vasovagal syncope: a diagnostic dilemma. Clinical Autonomic Research : official journal of the Clinical Autonomic Research Society, 27(4), 289-291. DOI: 10.1007/s10286-017-0424-8. DOI: https://doi.org/10.1007/s10286-017-0424-8
Rivasi, G., Torabi, P., Secco, G., Ungar, A., Sutton, R., Brignole, M., & Fedorowski, A. (2021). Age-related tilt test responses in patients with suspected reflex syncope. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 23(7), 1100-1105. DOI: 10.1093/europace/euab024. DOI: https://doi.org/10.1093/europace/euab024
Guieu, R., Degioanni, C., Fromonot, J., De Maria, L., Ruf, J., Deharo, J. C., & Brignole, M. (2022). Adenosine, Adenosine Receptors and Neurohumoral Syncope: From Molecular Basis to Personalized Treatment. Biomedicines, 10(5), 1127. DOI: 10.3390/biomedicines10051127. DOI: https://doi.org/10.3390/biomedicines10051127
Sutton, R. (2022). The role of adenosine in syncope. International Journal of Cardiology, 365, 47-48. DOI: 10.1016/j.ijcard.2022.07.036. DOI: https://doi.org/10.1016/j.ijcard.2022.07.036
Olshansky, B. (2017). Vasovagal Syncope: To Pace or Not to Pace. Journal of the American College of Cardiology, 70(14), 1729-1731. DOI: 10.1016/j.jacc.2017.08.025. DOI: https://doi.org/10.1016/j.jacc.2017.08.025
Villafane, J., Miller, J.R., Glickstein, J., Johnson, J.N., Wagner, J., Snyder, C.S., … Chowdhury, D. (2021). Loss of Consciousness in the Young Child. Pediatric cardiology, 42(2), 234-254. DOI: 10.1007/s00246-020-02498-6. DOI: https://doi.org/10.1007/s00246-020-02498-6
Vaddadi, G., Esler, M.D., Dawood, T., & Lambert, E. (2010). Persistence of muscle sympathetic nerve activity during vasovagal syncope. European Heart Journal, 31(16), 2027-2033. DOI: 10.1093/eurheartj/ehq071. DOI: https://doi.org/10.1093/eurheartj/ehq071
Kohno, R., Detloff, B.L.S., Chen, L.Y., Norby, F.L., & Benditt, D.G. (2019). Greater early epinephrine rise with head-up posture: A marker of increased syncope susceptibility in vasovagal fainters. Journal of Cardiovascular Electrophysiology, 30(3), 289-296. DOI: 10.1111/jce.13792. DOI: https://doi.org/10.1111/jce.13792
Torabi, P., Ricci, F., Hamrefors, V., Melander, O., Sutton, R., Benditt, D. G., & Fedorowski, A. (2019). Impact of Cardiovascular Neurohormones on Onset of Vasovagal Syncope Induced by Head-up Tilt. Journal of the American Heart Association, 8(12). DOI: 10.1161/JAHA.119.012559. DOI: https://doi.org/10.1161/JAHA.119.012559
Wagoner, A.L., Shaltout, H.A., Fortunato, J.E., & Diz, D.I. (2016). Distinct neurohumoral biomarker profiles in children with hemodynamically defined orthostatic intolerance may predict treatment options. American journal of physiology. Heart and Circulatory Physiology, 310(3), H416-H425. DOI: 10.1152/ajpheart.00583.2015. DOI: https://doi.org/10.1152/ajpheart.00583.2015
Benditt, D.G., van Dijk, J.G., Krishnappa, D., Adkisson, W.O., & Sakaguchi, S. (2020). Neurohormones in the Pathophysiology of Vasovagal Syncope in Adults. Frontiers in Cardiovascular Medicine, 7, 76. DOI: 10.3389/fcvm.2020.00076. DOI: https://doi.org/10.3389/fcvm.2020.00076
Nilsson, D., Sutton, R., Melander, O., & Fedorowski, A. (2016). Spontaneous vs nitroglycerin-induced vasovagal reflex on head-up tilt: Are there neuroendocrine differences?. Heart Rhythm, 13(8), 1674-1678. DOI: 10.1016/j.hrthm.2016.03.018. DOI: https://doi.org/10.1016/j.hrthm.2016.03.018
Torabi, P., Ricci, F., Hamrefors, V., Sutton, R., & Fedorowski, A. (2020). Classical and Delayed Orthostatic Hypotension in Patients With Unexplained Syncope and Severe Orthostatic Intolerance. Frontiers in Cardiovascular Medicine, 7, 21. DOI: 10.3389/fcvm.2020.00021. DOI: https://doi.org/10.3389/fcvm.2020.00021
Mu, D., Cheng, J., Qiu, L., & Cheng, X. (2022). Copeptin as a Diagnostic and Prognostic Biomarker in Cardiovascular Diseases. Frontiers in Cardiovascular Medicine, 9. DOI: 10.3389/fcvm.2022.901990. DOI: https://doi.org/10.3389/fcvm.2022.901990
Flevari, P., Leftheriotis, D., Kroupis, C., Antonakos, G., Lekakis, J., & Dima, K. (2017). Copeptin levels in patients with vasovagal syncope. International Journal of Cardiology, 230, 642-645. DOI: 10.1016/j.ijcard.2017.01.014. DOI: https://doi.org/10.1016/j.ijcard.2017.01.014
Lindenberger, M., Fedorowski, A., Melander, O., Gallo, W., Engvall, J., & Skoog, J. (2019). Cardiovascular biomarkers and echocardiographic findings at rest and during graded hypovolemic stress in women with recurrent vasovagal syncope. Journal of Cardiovascular Electrophysiology, 30(12), 2936-2943. DOI: 10.1111/jce.14207. DOI: https://doi.org/10.1111/jce.14207
Hamrefors, V., Nilsson, D., Melander, O., Sutton, R., & Fedorowski, A. (2017). Low Adrenomedullin and Endothelin-1 Predict Cardioinhibitory Response During Vasovagal Reflex in Adults Over 40 Years of Age. Circulation. Arrhythmia and Electrophysiology, 10(10). DOI: 10.1161/CIRCEP.117.005585.
Fedorowski, A., Burri, P., Struck, J., Juul-Möller, S., & Melander, O. (2013). Novel cardiovascular biomarkers in unexplained syncopal attacks: the SYSTEMA cohort. Journal of Internal Medicine, 273(4), 359-367. DOI: 10.1111/joim.12043. DOI: https://doi.org/10.1111/joim.12043
Rash, A., McRae, M., Fatehi, J., Richie, D., Solbiati, M., Pillay, N., … Sheldon, R. (2016). Assessment of endothelin and copeptin as biomarkers for vasovagal syncope. European Journal of Clinical Investigation, 46(2), 141-145. DOI: 10.1111/eci.12576. DOI: https://doi.org/10.1111/eci.12576
Lazurova, Z., Habalova, V., & Mitro, P. (2022). Association of polymorphisms in endothelin-1 and endothelin receptor a genes with vasovagal syncope. Physiological Research, 71(1), 93-101. DOI: 10.33549/physiolres.934689. DOI: https://doi.org/10.33549/physiolres.934689
Badertscher, P., Nestelberger, T., de Lavallaz, J.D.F., Than, M., Morawiec, B., Kawecki, D., … Mueller, C. (2017). Prohormones in the Early Diagnosis of Cardiac Syncope. Journal of the American Heart Association, 6(12). DOI: 10.1161/JAHA.117.006592. DOI: https://doi.org/10.1161/JAHA.117.006592
Liang, Y., Li, X., Tse, G., Li, G., Liu, W., & Liu, T. (2021). Diagnostic value of cardiac troponin I and N-terminal pro-B-Type Natriuretic Peptide in cardiac syncope. Current Research in Physiology, 4, 24-28. DOI: 10.1016/j.crphys.2021.01.003. DOI: https://doi.org/10.1016/j.crphys.2021.01.003
Thiruganasambandamoorthy, V., McRae, A.D., Rowe, B.H., Sivilotti, M.L.A., Mukarram, M., Nemnom, M.J., … Taljaard, M. (2020). Does N-Terminal Pro-B-Type Natriuretic Peptide Improve the Risk Stratification of Emergency Department Patients With Syncope? Annals of Internal Medicine, 172(10), 648-655. DOI: 10.7326/M19-3515. DOI: https://doi.org/10.7326/M19-3515
Jiang, W., & Zheng, S. (2022). Structural insights into galanin receptor signaling. Proceedings of the National Academy of Sciences of the United States of America, 119(21). DOI: 10.1073/pnas.2121465119. DOI: https://doi.org/10.1073/pnas.2121465119
Plasek, J., Doupal, V., Furstova, J., Furst, T., Safarcik, K., Krnacova, A., … Taborsky, M. (2013). The role of adrenomedullin and galanin in recurrent vasovagal syncope: a case control study. Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia, 157(2), 162-167. DOI: 10.5507/bp.2011.061. DOI: https://doi.org/10.5507/bp.2011.061
Chou, K.L., Dayalu, P., Koeppe, R.A., Gilman, S., Spears, C.C., Albin, R.L., & Kotagal, V. (2022). Serotonin Transporter Imaging in Multiple System Atrophy and Parkinson's Disease. Movement Disorders : official journal of the Movement Disorder Society, 37(11), 2301-2307. DOI: 10.1002/mds.29220. DOI: https://doi.org/10.1002/mds.29220
Raziq, H., Fayyaz, H., Azhar, R., Hayyat, A., & Waqas, S. (2021). Association of serotonin levels in patients of vasovagal syncope and postural tachycardia syndrome. JPMA. The Journal of the Pakistan Medical Association, 71(8), 1963-1966. DOI: 10.47391/JPMA.053. DOI: https://doi.org/10.47391/JPMA.053
Sheldon, R., Rose, M.S., Ritchie, D., Martens, K., Maxey, C., Jagers, … Gerull, B. (2019). Genetic Association Study in Multigenerational Kindreds With Vasovagal Syncope: Evidence for Involvement of Sex-Specific Serotonin Signaling. Circulation. Arrhythmia and Electrophysiology, 12(1). DOI: 10.1161/CIRCEP.118.006884.
Butler, I.J., Lankford, J.E., Hashmi, S.S., & Numan, M.T. (2014). Biogenic amine metabolism in juvenile neurocardiogenic syncope with dysautonomia. Annals of Clinical and Translational Neurology, 1(4), 251-257. DOI: 10.1002/acn3.49. DOI: https://doi.org/10.1002/acn3.49
Yan, H., Wang, S., Cai, H., Zhang, J., Liu, P., Wang, Y., … Wang, C. (2021). Prognostic Value of Biomarkers in Children and Adolescents With Orthostatic Intolerance. Frontiers in Pediatrics, 9. DOI: 10.3389/fped.2021.752123. DOI: https://doi.org/10.3389/fped.2021.752123
Li, H., Zhang, F., Wang, Y., Liu, P., Zhang, C., Feng, X., … Jin, H. (2015). Predictive value of baseline plasma midregional fragment of pro-adrenomedullin level on long-term outcome of postural tachycardia syndrome children treated with midodrine hydrochloride. Zhonghua xin xue guan bing za zhi, 43(6), 507-510.
Yang, J., Zhao, J., Du, S., Liu, D., Fu, C., … Jin, H. (2013). Postural orthostatic tachycardia syndrome with increased erythrocytic hydrogen sulfide and response to midodrine hydrochloride. The Journal of Pediatrics, 163(4), 1169-1173.e2. DOI: 10.1016/j.jpeds.2013.04.039. DOI: https://doi.org/10.1016/j.jpeds.2013.04.039
Yang, J., Li, H., Ochs, T., Zhao, J., Zhang, Q., Du, S., … Jin, H. (2015). Erythrocytic hydrogen sulfide production is increased in children with vasovagal syncope. The Journal of Pediatrics, 166(4), 965-969. DOI: 10.1016/j.jpeds.2014.12.021. DOI: https://doi.org/10.1016/j.jpeds.2014.12.021
Lin, J., Shen, J., Liu, J., Cheng, W., Li, L., & Jiao, F. (2022). Whole-Blood MicroRNA Sequence Profiling and Identification of Specific miR-21 for Adolescents With Postural Tachycardia Syndrome. Frontiers in Neuroscience, 16. DOI: 10.3389/fnins.2022.920477. DOI: https://doi.org/10.3389/fnins.2022.920477
Pietrucha, A.Z. (2014). Endothelial function in vasovagal syncope. Expert Review of Cardiovascular Therapy, 12(12), 1387-1389. DOI: 10.1586/14779072.2014.982095. DOI: https://doi.org/10.1586/14779072.2014.982095
Hamrefors, V., Nilsson, D., Melander, O., Sutton, R., & Fedorowski, A. (2017). Low Adrenomedullin and Endothelin-1 Predict Cardioinhibitory Response During Vasovagal Reflex in Adults Over 40 Years of Age. Circulation. Arrhythmia and Electrophysiology, 10(10). DOI: /10.1161/CIRCEP.117.005585. DOI: https://doi.org/10.1161/CIRCEP.117.005585
Shende, P., & Desai, D. (2020). Physiological and Therapeutic Roles of Neuropeptide Y on Biological Functions. Advances in Experimental Medicine and Biology, 1237, 37-47. DOI: 10.1007/5584_2019_427. DOI: https://doi.org/10.1007/5584_2019_427
Liao, Y., Xu, W.R., Li, H.X., Tang, C.S., Jin, H.F., & Du, J.B. (2017). Plasma Neuropeptide Y Levels in Vasovagal Syncope in Children. Chinese Medical Journal, 130(23), 2778-2784. DOI: 10.4103/0366-6999.219157. DOI: https://doi.org/10.4103/0366-6999.219157
Komiyama, T., Nagata, E., Hashida, T., Sakama, S., Ayabe, K., Kamiguchi, H., … Kobayashi, H. (2019). Neurally mediated syncope diagnosis based on adenylate cyclase activity in Japanese patients. PloS One, 14(4). DOI: 10.1371/journal.pone.0214733. DOI: https://doi.org/10.1371/journal.pone.0214733
Hasegawa, M., Komiyama, T., Ayabe, K., Sakama, S., Sakai, T., Lee, K.H., … Ikari, Y. (2021). Diagnosis and prevention of the vasodepressor type of neurally mediated syncope in Japanese patients. PloS One, 16(6). DOI: 10.1371/journal.pone.0251450. DOI: https://doi.org/10.1371/journal.pone.0251450
Bai, W., Chen, S., Tang, C.S., Qi, J.G., Cui, Q.H., Xu, M., … Jin, H.F. (2019). Gut microbiota analysis and its significance in vasovagal syncope in children. Chinese Medical Journal, 132(4), 411-419. DOI: 10.1097/CM9.0000000000000086. DOI: https://doi.org/10.1097/CM9.0000000000000086
Raharjo, S.B., Maulana, R., Maghfirah, I., Alzahra, F., Putrinarita, A.D., Hanafy, D.A., & Yuniadi, Y. (2018). SCN5A gene mutations and the risk of ventricular fibrillation and syncope in Brugada syndrome patients: A meta-analysis. Journal of Arrhythmia, 34(5), 473-477. DOI: 10.1002/joa3.12097. DOI: https://doi.org/10.1002/joa3.12097
Wallace, E., Howard, L., Liu, M., O'Brien, T., Ward, D., Shen, S., & Prendiville, T. (2019). Long QT Syndrome: Genetics and Future Perspective. Pediatric Cardiology, 40(7), 1419-1430. DOI: 10.1007/s00246-019-02151-x. DOI: https://doi.org/10.1007/s00246-019-02151-x
Sheldon, R.S., & Gerull, B. (2021). Genetic markers of vasovagal syncope. Autonomic Neuroscience : Basic & Clinical, 235. DOI: 10.1016/j.autneu.2021.102871. DOI: https://doi.org/10.1016/j.autneu.2021.102871
Márquez, M.F., Fragoso, J.M., Pérez-Pérez, D., Cázares-Campos, I., Totomoch-Serra, A., Gómez-Flores, J.R., & Vargas-Alarcón, G. (2019). Polymorphisms in B-Adrenergic Receptors Are Associated with Increased Risk to Have a Positive Head-Up Tilt Table Test in Patients with Vasovagal Syncope. Revista de investigacion clinica; organo del Hospital de Enfermedades de la Nutricion, 71(2), 124-132. DOI: 10.24875/RIC.18002734. DOI: https://doi.org/10.24875/RIC.18002734
Atici, A., Rasih-Sonsoz, M., Ali-Barman, H., Durmaz, E., Demirkiran, A., Gulsen, K., … Kaya Bilge, A. (2020). The role of Beta-1 receptor gene polymorphism in Beta-Blocker therapy for vasovagal syncope. Revista de investigacion clinica; organo del Hospital de Enfermedades de la Nutricion, 72(5). DOI: 10.24875/RIC.20003319. DOI: https://doi.org/10.24875/RIC.20003319
Sheldon, R., Rose, M.S., Ritchie, D., Martens, K., Maxey, C., Jagers, J., … Gerull, B. (2019). Genetic Association Study in Multigenerational Kindreds With Vasovagal Syncope: Evidence for Involvement of Sex-Specific Serotonin Signaling. Circulation. Arrhythmia and Electrophysiology, 12(1). DOI: 10.1161/CIRCEP.118.006884. DOI: https://doi.org/10.1161/CIRCEP.118.006884
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Actual Problems of Pediatrics, Obstetrics and Gynecology
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish in this journal agree to the following terms:
1. The authors reserve the right to authorship of the work and pass the journal right of first publication of this work is licensed under a Creative Commons Attribution License, which allows others to freely distribute the work published with reference to the authors of the original work and the first publication of this magazine.
2. Authors are entitled to enter into a separate agreement on additional non-exclusive distribution of work in the form in which it was published in the magazine (eg work place in the electronic repository institution or publish monographs in part), provided that the reference to the first publication of this magazine.
3. Policy magazine allows and encourages authors placement on the Internet (eg, in storage facilities or on personal websites) manuscript of how to submit the manuscript to the editor and during his editorial processing, since it contributes to productive scientific discussion and positive impact on the efficiency and dynamics of citing published work (see. The Effect of Open Access).
