Key result
Non-prodromal vasovagal syncope is linked to ~33-point higher male prevalence alongside older age and higher BMI.
Why the study?
The clinical characteristics of sudden-onset vasovagal syncope without prodromal symptoms remain unclear despite its increased risk of falls and harm.
Observational (n=221)
No
Absolute Event Rate: 70.59% vs 37.29%
p-value: p=<0.001
Non-prodromal vasovagal syncope represents a distinct clinical phenotype associated with older age, male sex, higher BMI, and a potential increased risk of fall injuries due to the absence of warning signs.
Non-prodromal vasovagal syncope may indicate higher fall risk; hypothesis-generating for demographic predictors in prospective cohorts.
Sudden-onset vasovagal syncope (VVS) without prodromal symptoms increases the risk of falls and harm. However, the clinical characteristics of this condition remain unclear. This study aimed to compare the clinical characteristics of patients with VVS presenting with and without prodromal symptoms. We retrospectively and consecutively enrolled 221 patients with suspected syncope who underwent head-up tilt testing (VVS with no presyncope, n = 34; VVS with presyncope, n = 118; non-syncope, n = 69). Demographics, comorbidities, syncope symptoms, and examination findings were compared between the groups. Patients with non-prodromal VVS accounted for 22.4% of all VVS cases. The non-prodromal VVS group was older (median: 47 years), predominantly male (70.59%), and had a higher body mass index (median: 24.14 kg/m²) compared with the prodromal VVS group (all P values < 0.05). The non-prodromal VVS group had a shorter disease duration (median: 1 vs. 12 months) and higher incidence of falls (76.5% vs. 58.5%) than the prodromal VVS group. The top three triggers for both non-prodromal and prodromal VVS were standing up, exercising, and fatigue. The top three most common prodromal symptoms in patients with prodromal VVS were dizziness (73.7%), amaurosis (52.6%), and sweating (31.3%). Patients with non-prodromal VVS were older and more likely to be male and had a higher body mass index, shorter course of disease, and higher incidence of falls. Future studies should investigate the mechanisms of cardiocerebral hemodynamics and neural reflex regulation in patients with non-prodromal VVS.
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Yu et al. (2026) conducted an observational in Vasovagal syncope (n=221). Non-prodromal vasovagal syncope vs. Prodromal vasovagal syncope was evaluated on Male sex proportion (p=<0.001). Patients with non-prodromal vasovagal syncope were older, more likely to be male (70.59% vs 37.29%), and had a higher body mass index compared to those with prodromal symptoms.
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