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Gut microbiota analysis and its significance in vasovagal syncope in children

Chinese Medical Journal 2019年第4期132卷 411-419页

作者： Wei Bai Selena Chen Chao-Shu Tang Jian-Guang Qi Qing-Hua Cui Ming XU Jun-Bao Du Hong-Fang Jin Department of Pediatrics Peking University First HospitalBeijing 100034China Department of Biochemistry and Cellular Biology University of CaliforniaSan DiegoLa JollaCA 92093USA Department of Physiology and Pathophysiology Peking University Health Sciences CentreBeijing 100191China Key Laboratory of Molecular Cardiovascular Sciences The Ministry of EducationBeijing 100191China Department of Biomedical Informatics Peking University Health Sciences CentreBeijing 100191China Institute of Vascular Research Peking University Third HospitalBeijing 100191China.

Background: vasovagal syncope (VVS) is common in children and greatly affect both physical and mental health. But the mechanisms have not been completely explained. This study was designed to analyze the gut microbiota in children with VVS and explore its clinical significance. Methods: Fecal samples from 20 VVS children and 20 matched controls were collected, and the microbiota were analyzed by 16S rRNA gene sequencing. The diversity and microbiota compositions of the VVS cases and controls were compared with the independent sample t test or Mann-Whitney U test. The correlation between the predominant bacteria and clinical symptoms was analyzed using Pearson or Spearman correlation test. Results: No significant differences in diversity were evident between VVS and controls (P > 0.05). At the family level, the relative abundance of Ruminococcaceae was significantly higher in VVS children than in controls (median [Q1, Q3]: 22.10% [16.89%, 27.36%] vs. 13.92% [10.31%, 20.18%], Z=-2.40, P 4, P < 0.05). The relative abundance of Ruminococcaceae in VVS patients was positively correlated with the frequency of syncope (r= 0.616, P < 0.01). In terms of its correlation with hemodynamics, we showed that relative abundance of Ruminococcaceae was negatively correlated with the systolic and diastolic pressure reduction at the positive response in head-up tilt test (HUTT;r= -0.489 and -0.448, all P < 0.05), but was positively correlated with the mean pressure drop and decline rate (r= 0.489 and 0.467, all P < 0.05) as well as diastolic pressure drop and decline rate at the HUTT positive response (r= 0.579 and 0.589, all P < 0.01) in VVS patients. Conclusion: Ruminococcaceae was the predominant gut bacteria and was associated with the clinical symptoms and hemodynamics of VVS, suggesting that gut microbiota might be involved in the development of VVS.

关键词： vasovagal syncope Gut microbiota Ruminococcaceae Children

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Autonomic Nervous Function in vasovagal Syncope of Children and Adolescents

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Neuroscience Bulletin 2019年第5期35卷 937-940页

作者： Chunyan Tao Chaoshu Tang Selena Chen Hongfang Jin Junbao Du Department of Pediatrics Peking University First Hospital Beijing 100034 China Department of Physiology and Pathophysiology Peking University Health Sciences Centre Beijing 100191 China Division of Biological Sciences University of California San Diego CA 92093 USA Key Laboratory of Molecular Cardiovascular Sciences Ministry of Education of China Beijing 100191 China

Syncope is defined as a transient loss of consciousness due to global cerebral hypoperfusion, accompanied by loss of muscle tone and failure to maintain an active position. vasovagal syncope (VVS) is the most common presentation of syncope, and its diagnostic criteria include:(1) absence of any other evident etiology for syncope or presyncope,(2) positive response to head-up tilt test with evident vasovagal reaction (hypotension and/or bradycardia), and (3) no concomitant chronic or acute disease [1, 2]. The onset of VVS peaks initially in childhood and adolescence, and accounts for 60%–70% of all syncopal cases. Clinicians pay great attention to syncope among children and adolescents, due to its high prevalence and its impact on patients’ quality of life. Affected individuals often experience mental stress, economic burdens, and accidental bodily injuries related to syncope [2]. While the pathogenesis of VVS is not fully understood, autonomic nervous dysfunction has been identified as a contributing mechanism. The examination of autonomic nervous function can provide important information about patients with syncope.

关键词： Autonomic Nervous Function vasovagal Syncope Children Adolescents

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Different treatments for different mechanisms in vasovagal syncope

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Journal of Geriatric Cardiology 2006年第1期3卷 61-64页

作者： Quan FANG Kangan CHENG Hua DENG Ning WU Department of Cardiology Peking Union Medical College Hospital Chinese Academy of Medical Sciences Department of Cardiology Peking Union Medical College Hospital Chinese Academy of Medical Sciences Department of Cardiology Peking Union Medical College Hospital Chinese Academy of Medical Sciences Department of Cardiology Peking Union Medical College Hospital Chinese Academy of Medical Sciences

The treatment of vasovagal syncope has been by far unsatisfactory. Beta-blockers may prevent vasovagal syncope, but they exacerbates heart asystole. Cardiac pacing prevents syncope but notpresyncope. The frequent, serious vasovagal syncope attacks of a 63- year-old woman patient were completely prevented by administration of 100 mg metoprolol (b.i.d) for 3 months until the patient experienced a complete heart block. A DDD pacemaker implantation abolished syncope but not the presyncope, which was eventually prevented in a follow-up period of 24 months by adding 75 mg atenalol twice a day. This case suggests a different mechanism involved in vasovagal syncope.

关键词： vasovagal syncope beta-blocker cardiac pacing tilt table test heart block

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Myoclonus and Recurrent Cardioinhibitory vasovagal Syncope after Abdominal Surgery in a Critical Care Setting

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World Journal of Cardiovascular Diseases 2020年第5期10卷 274-277页

作者： Ana Belén Fernández Elena Martín Ramsés Marrero David Viera Department of Anesthesiology and Postsurgical Intensive Care Unit Ntra Sra De Candelaria University Hospital Santa Cruz de Tenerife Spain

Letter to the

关键词： vasovagal Reflex Syncope Cardioinhibitory Response Autonomic Failure Asystole

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Lung cancer： a rare cause of recurrent syncope after pacemaker implantation

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Chinese Medical Journal 2013年第10期126卷 1992-1993页

作者： LI Yong-bin YAO Zhu-hua CAO Yue-juan WANG Ru Department of Cardiology Tianjin Union Medicine Center Tianjin300121 China

Syncope is an important problem in clinical practice; however, in nearly one third of cases reported thecertain reason of syncope could not be tbund even with advanced technology. The causes of syncope include reflex mediated, cardiac, neurological and cerebrovascular, but some uncommon causes should be kept in mind to avoid misdiagnosis.

关键词： syncope vasovagal reflex lung neoplasms

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Management and therapy of vasovagal syncope: A review

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World Journal of Cardiology 2010年第10期2卷 308-315页

作者： Muhammet Ali Aydin Tushar V Salukhe Iris Wilke Stephan Willems Department of Electrophysiology University Heart Center Hamburg

vasovagal syncope is a common cause of recurrent syncope. Clinically, these episodes may present as an isolated event with an identifiable trigger, or manifest as a cluster of recurrent episodes warranting intensive evaluation. The mechanism of vasovagal syncope is incompletely understood. Diagnostic tools such as implantable loop recorders may facilitate the identification of patients with arrhythmia mimicking benign vasovagal syncope. This review focuses on the management of vasovagal syncope and discusses the non-pharmacological and pharmacological treatment options, especially the use of midodrine and selective serotonin reuptake inhibitors. The role of cardiac pacing may be meaningful for a subgroup of patients who manifest severe bradycardia or asystole but this still remains controversial.

关键词： vasovagal syncope Midodrine Adrenergic β-antagonists Serotonin uptake inhibitors

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