20 research outputs found
Vasovagal syncope: a prospective, randomized, crossover evaluation of the effect of propranolol, nadolol and placebo on syncope recurrence and patients’ well-being
AbstractObjectivesWe sought to assess the relative therapeutic efficacy of propranolol, nadolol and placebo in recurrent vasovagal syncope (VVS).BackgroundCentral and peripheral mechanisms have been implicated in the pathogenesis of VVS. Propranolol, nadolol and placebo have different sites of action on central and/or peripheral mechanisms. It has not yet been clarified whether one of the aforementioned treatments is more efficient than the others in reducing clinical episodes and exerting a beneficial effect on patients’ well-being.MethodsWe studied 30 consecutive patients with recurrent VVS and a positive head-up tilt test. All were serially and randomly assigned to propranolol, nadolol or placebo. Therapy with each drug lasted three months. On the day of drug crossover, patients reported the total number of syncopal and presyncopal attacks during the previous period. They also gave a general assessment of their quality of life, taking into account: 1) symptom recurrence; 2) drug side effects; and 3) their personal well-being during therapy (scale 0 to 4: 0 = very bad/discontinuation; 1 = bad; 2 = good; 3 = very good; 4 = excellent). At the end of the nine-month follow-up period, they reported whether they preferred a specific treatment over the others.ResultsSpontaneous syncopal and presyncopal episode recurrence during each three-month follow-up period was reduced by all drugs tested (analysis of variance [ANOVA]: chi-square = 67.4, p < 0.0001 for syncopal attacks; chi-square = 60.1, p < 0.0001 for presyncopal attacks) No differences were observed in the recurrence of syncope and presyncope among the three drugs. All drugs improved the patients’ well-being (ANOVA: chi-square = 61.9, p < 0.0001).ConclusionsPropranolol, nadolol and placebo are equally effective treatments in VVS, as demonstrated by a reduction in the recurrence of syncope and presyncope, as well as an improvement in the patients’ well-being
Neurocardiogenic mechanisms of unexplained syncope in idiopathic dilated cardiomyopathy
Syncope in patients with advanced heart failure is a sign of poor
prognosis. The cause of syncope in patients with dilated cardiomyopathy
(DC) is not fully recognized and may remain elusive even after
standardized evaluation. The purpose of the present study was to examine
the implication of neurally mediated mechanisms in the pathophysiology
of syncopal episodes in patients with DC. Twenty-six patients (21 men, 5
women; mean age 59 +/- 2 years, range 38 to 79) with DC and left
ventricular ejection fractions <= 40% were included in the study.
Thirteen patients with unexplained syncope or presyncope and a control
group of 13 patients without unexplained syncope underwent head-up tilt
tests with clomipramine challenge. The 2 groups were matched with regard
to age, gender, and left ventricular ejection fractions, and there were
no major differences in terms of medication. Heart rate variability
analysis, and plethysmography of forearm flow were performed during the
tilt tests. Blood samples were also drawn for catecholamine
measurements. In the group with histories of unexplained syncope, the
head-up tilt test results were positive in 11 patients (84.6%).
Sympathetic and parasympathetic heart rate indexes were markedly
stimulated, while catecholamine concentrations and blood flow changes
indicated sympathetic withdrawal during tilting. In the control group,
the head-up tilt test results were negative in 12 patients (92.3%). In
conclusion, neurally mediated mechanisms seem to be implicated in the
pathophysiology of syncope in patients with DC and should therefore be
considered in the differential diagnosis of syncopal episodes of
unexplained origin. (c) 2007 Elsevier Inc. All rights reserved
VRADA training system as a non-pharmacological dual intervention to alleviate symptoms of the pathophysiology of Mild Cognitive Impairment
In this study, a VR system called VRADA (VR Exercise App for Dementia and Alzheimer's Patients) was designed for physical and cognitive training forindividuals with Mild Cognitive Impairment (MCI). The inflammatory factors IL-1β and TNF-α, Alzheimer's disease (AD) hallmarks total tau, p181-tau, Αβ42 and Aβ40, the ratio of Aβ42/40 and p181-tau/Aβ42 were assessed on the blood serum of patients diagnosed with MCI to determine the effect of VRADA training. No significant differences were verified in the levels of inflammatory markers after the end of the study, however IL-1β levels of the VRADA group were significantly lower than those of the control group, at the follow-up of the study. Also, patients following VRADA intervention presented significantly higher Αβ42/Αβ40 ratio, and lower levels of Αβ42, of total tau, p-tau181, and of the crucial ratio p-tau181/Αβ42, in comparison with patients of the Control group. These results are promising for the further employment of the VRADA training during early dementia, and hopefully for halting the progression to AD