{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T19:41:37Z","timestamp":1794339697541,"version":"4.9.0"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2024,12,30]],"date-time":"2024-12-30T00:00:00Z","timestamp":1735516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"BIBLIOSAN"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,3,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Identifying the haemodynamic mechanism of autonomic syncope is the essential pre-requisite for effective and personalized therapy aimed at preventing recurrences. The present study assessed the diagnostic efficacy of a two-step assessment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Multicentre prospective, cross-sectional, observational study. Patients affected by severe autonomic syncope underwent a two-step assessment including 24-h ambulatory blood pressure monitoring and short cardiovascular autonomic function assessment (SCAFA). SCAFA consisted of carotid sinus massage (CSM), performed in patients \u226540 years old, a passive standing test, and a \u2018fast\u2019 head-up tilt test scheduled sequentially during one session on a tilt table.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The study population consisted of 333 patients, 102 \u2264 40 years old and 231 &amp;gt; 40 years old. Any positive response was observed in 298 (89%) patients (92 [92%] in younger and 134 [89%] in older), with hypotensive phenotype accounting for 226 (68%), bradycardic phenotype for 21 (6%) and mixed phenotype for 51 (15%) of cases. The mean duration of the SCAFA procedure was 25 (IQR 20\u201332) min. Ambulatory blood pressure monitoring, CSM, passive standing, and head-up tilt test were positive in 60%, 15%, 3%, and 71% of patients, respectively. More than one test was positive in 51% and 49% of patients \u226440 and &amp;gt;40 years, respectively. Large inter-centre variability of CSM positivity rate, which remained significant after adjustment for demographic and clinical variables, was observed (P = .003).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The standardized 2STEPS protocol offers an easy-to-perform and time-saving diagnostic work-up allowing identification of the haemodynamic mechanism of loss of consciousness in most patients with autonomic syncope. This protocol provides the necessary background for a personalized mechanism-specific therapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eurheartj\/ehae907","type":"journal-article","created":{"date-parts":[[2024,12,13]],"date-time":"2024-12-13T07:29:10Z","timestamp":1734074950000},"page":"827-835","source":"Crossref","is-referenced-by-count":26,"title":["Mechanism of syncope: role of ambulatory blood pressure monitoring and cardiovascular autonomic function assessment"],"prefix":"10.1093","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-3386-6685","authenticated-orcid":false,"given":"Antonella","family":"Groppelli","sequence":"first","affiliation":[{"name":"Department of Cardiology, IRCCS Istituto Auxologico Italiano, Faint and Fall Research Centre, S. 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CIBER-CV , Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0162-5851","authenticated-orcid":false,"given":"Roberto","family":"Maggi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ospedali del Tigullio , Lavagna ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Artur","family":"Fedorowski","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Karolinska University Hospital , Stockholm ,","place":["Sweden"]},{"name":"Department of Medicine, Karolinska Institute , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Ungar","sequence":"additional","affiliation":[{"name":"Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi , Florence ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9402-7439","authenticated-orcid":false,"given":"Gianfranco","family":"Parati","sequence":"additional","affiliation":[{"name":"Department of Cardiology, IRCCS Istituto Auxologico Italiano, Faint and Fall Research Centre, S. 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