{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T18:06:16Z","timestamp":1770919576221,"version":"3.50.1"},"reference-count":32,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2019,6,18]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Vasovagal reflex is the most common form of syncope, but the pathophysiological mechanisms that initiate the reflex are not well understood. We aimed to study supine and early orthostatic levels of the neurohormones involved in control of circulatory homeostasis in relation to the onset of tilt\u2010induced vasovagal syncope (VVS).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              A total of 827 patients who were investigated for unexplained syncope with head\u2010up tilt test (HUT) and\u00a0optional nitroglycerin provocation (Italian protocol) had blood samples collected while supine and after 3\u2010minutes of HUT.\u00a0Of these, 173 (20.9%) patients developed VVS during drug\u2010free HUT, 161 of whom (males 44.7%; age 45\u00b121\u00a0years) had complete data. We analyzed levels of epinephrine, norepinephrine, C\u2010terminal pro\u2013arginine vasopressin, C\u2010terminal endothelin\u20101, and midregional fragments of pro\u2013atrial natriuretic peptide and pro\u2010adrenomedullin in relation to time from\u00a0tilt\u2010up to onset of VVS. We applied a linear regression model adjusted for age and sex. The mean time to syncope was 11\u00b17\u00a0minutes. Older age (\u03b2=0.13; SE=0.03,\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001), higher supine systolic blood pressure (\u03b2=0.06; SE=0.03,\n              <jats:italic>P<\/jats:italic>\n              =0.02), and\u00a0higher supine midregional fragment of pro\u2010adrenomedullin predicted longer time to syncope (\u03b2=2.31; SE=0.77,\n              <jats:italic>P<\/jats:italic>\n              =0.003), whereas supine levels of other neurohormones were not associated with time to syncope. Among 151 patients\u00a0who\u00a0developed VVS later than 3 minutes of HUT, increase in epinephrine (\u03b2=\u22123.24; SE=0.78,\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) and C\u2010terminal pro\u2013arginine vasopressin (\u03b2=\u22122.07; SE=0.61,\n              <jats:italic>P<\/jats:italic>\n              =0.001) at 3 minutes of HUT were related to shorter time to syncope.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Older age, higher blood pressure, and higher level of pro\u2010adrenomedullin are associated with later onset of VVS during tilt testing, whereas greater increase of tilt\u2010induced epinephrine and vasopressin release correlate with shorter time to syncope.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.119.012559","type":"journal-article","created":{"date-parts":[[2019,6,18]],"date-time":"2019-06-18T09:00:20Z","timestamp":1560848420000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":25,"title":["Impact of Cardiovascular Neurohormones on Onset of Vasovagal Syncope Induced by Head\u2010up Tilt"],"prefix":"10.1161","volume":"8","author":[{"given":"Parisa","family":"Torabi","sequence":"first","affiliation":[{"name":"Department of Clinical Sciences Lund University Malm\u00f6 Sweden"},{"name":"Department of Clinical Physiology Sk\u00e5ne University Hospital Malm\u00f6 Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabrizio","family":"Ricci","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Lund University Malm\u00f6 Sweden"},{"name":"Department of Neuroscience, Imaging and Clinical Sciences \u201cG. d'Annunzio\u201d University Chieti Italy"},{"name":"Fondazione Villa Serena per la Ricerca Citt\u00e0 Sant'Angelo Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Viktor","family":"Hamrefors","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Lund University Malm\u00f6 Sweden"},{"name":"Department of Internal Medicine Sk\u00e5ne University Hospital Malm\u00f6 Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olle","family":"Melander","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Lund University Malm\u00f6 Sweden"},{"name":"Department of Internal Medicine Sk\u00e5ne University Hospital Malm\u00f6 Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard","family":"Sutton","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute Imperial College Hammersmith Hospital Campus London United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David G.","family":"Benditt","sequence":"additional","affiliation":[{"name":"Cardiac Arrhythmia Center Cardiovascular Division University of Minnesota Minneapolis MN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Artur","family":"Fedorowski","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Lund University Malm\u00f6 Sweden"},{"name":"Department of Cardiology Sk\u00e5ne University Hospital Malm\u00f6 Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy037"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000498"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1111\/jce.13810"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9149(9X)00084-9"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.117.005585"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1111\/joim.12043"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2012.07.028"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/jce.13792"},{"key":"e_1_3_1_10_2","first-page":"121","article-title":"Echocardiographic end endocrine changes during vasovagal syncope induced by prolonged head\u2010up tilt","volume":"2","author":"Fitzpatrick A","year":"1992","unstructured":"Fitzpatrick A, Williams TR, Ahmed R, Lightman SL, Bloom SR, Sutton R. 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