{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T07:04:47Z","timestamp":1761807887009},"reference-count":24,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2014,8,19]],"date-time":"2014-08-19T00:00:00Z","timestamp":1408406400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pacing Clinical Electrophis"],"published-print":{"date-parts":[[2014,12]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Vasovagal syncope (VVS) is the result of an autonomic reflex that has a final effect of reducing sympathetic drive and increasing vagal activity. However, whether syncopal symptoms are associated with pathological cardiac autonomic modulation is not fully known. We tested the hypothesis that cardiac autonomic function is impaired in patients with VVS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Eighty\u2010four consecutive patients (59 males; 48.8 \u00b1 20.9 years) with recurrent unexplained syncope were enrolled. The head\u2010up tilt test (HUTT) was positive in 38 patients and negative in 46 patients. Cardiac autonomic function was assessed by baroreflex sensitivity (BRS), heart rate variability, plasma concentrations of norepinephrine, and <jats:sup>123<\/jats:sup>I\u2010metaiodobenzylguanidine (MIBG) scintigraphy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>BRS indices were significantly lower in the HUTT\u2010positive group than in the HUTT\u2010negative group (6.1 \u00b1 5.5 mm Hg\/s vs 9.8 \u00b1 7.6 mm Hg\/s, P = 0.02). With regard to cardiac <jats:sup>123<\/jats:sup>I\u2010MIBG scintigraphy, the mean heart\u2010to\u2010mediastinum ratio at the delayed phase tended to be lower in HUTT\u2010positive than in HUTT\u2010negative individuals, but this difference was not significant (2.75 \u00b1 0.55 vs 3.02 \u00b1 0.49, P = 0.08).The percent washout rate of <jats:sup>123<\/jats:sup>I\u2010MIBG was significantly higher in the positive group compared with the negative group (40.7 \u00b1 13.1% vs 31.5 \u00b1 13.3%, P = 0.02). Multivariate logistic analysis revealed that the appearance of HUTT\u2010induced VVS was predicted independently by a high percent washout rate of <jats:sup>123<\/jats:sup>I\u2010MIBG (odds ratio, 0.954; 95% confidence interval, 0.903\u20130.998; P = 0.048).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our results suggest that pathological autonomic cardiac modulation may play a role in the appearance of syncope in VVS patients.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pace.12484","type":"journal-article","created":{"date-parts":[[2014,8,20]],"date-time":"2014-08-20T02:09:40Z","timestamp":1408500580000},"page":"1694-1701","source":"Crossref","is-referenced-by-count":19,"title":["Cardiac Autonomic Dysfunction in Patients with Head\u2010up Tilt Test\u2010Induced Vasovagal Syncope"],"prefix":"10.1111","volume":"37","author":[{"given":"TETSUJI","family":"SHINOHARA","sequence":"first","affiliation":[{"name":"Department of Cardiology and Clinical Examination 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