Key result
In patients with severe aortic stenosis, a greater decrease in carotid artery peak systolic velocity during an orthostatic stress test was independently associated with syncope (OR 0.818 per 1 cm/s).
Why the study?
Does an orthostatic stress test predict syncope in patients with severe aortic stenosis?
Observational (n=108)
No
Does an orthostatic stress test predict syncope in patients with severe aortic stenosis?
An orthostatic stress test demonstrating a decrease in carotid and vertebral arterial flow velocities is independently associated with syncope in patients with severe aortic stenosis.
May aid syncope risk stratification in severe aortic stenosis; leaves open need for prospective validation before clinical adoption.
BACKGROUND: There is a paucity of data regarding response of cerebral blood flow to the postural unloading maneuver and its impact on the risk of syncope in patients with aortic stenosis (AS). The aim of the present study was to assess effects of orthostatic stress test on changes in carotid and vertebral artery blood flow and its association with syncope in patients with severe AS. METHODS: 108 patients were enrolled (72 with and 36 patients without syncope) with severe isolated severe AS. Peak systolic blood-flow velocity (PSV) and end-diastolic velocity in the carotid arteries and vertebral arteries were measured by duplex ultrasound in the supine position and at 1-2 min after the assumption of the standing position. RESULTS: The orthostatic stress test induced a significant decrease in carotid and vertebral arterial flow velocities in all examined arteries (p < 0.001). The median (interquartile range) of mean change in PSV for carotid arteries was higher for patients with syncope (syncope [-] vs. syncope [+]: -0.6 cm/s [-1.8, 1.0] vs. -7.3 cm/s [-9.5, -2.0]; p < 0.001) and similarly for vertebral arteries (-0.5 cm/s [-2.0, 0.5] vs. -4.8 cm/s [-6.5, -1.3]; p < 0.001, respectively). Age, aortic valve area, and mean change in PSV for carotid arteries were independently associated with syncope. CONCLUSIONS: In patients with AS, a decrease in carotid and vertebral arterial flow velocities in the standing position was observed and was associated with syncope. The present findings may support the value of an orthostatic test in identifying patients with severe AS and a high risk of syncope.
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Kleczyński et al. (2018) conducted an observational in Severe isolated aortic stenosis (n=108). Orthostatic stress test vs. Patients without syncope was evaluated on Mean change in peak systolic velocity (PSV) for carotid arteries during orthostatic stress test (OR 0.818, 95% CI 0.673-0.995, p=0.044). In patients with severe aortic stenosis, a greater decrease in carotid artery peak systolic velocity during an orthostatic stress test was independently associated with syncope (OR 0.818 per 1 cm/s).
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