ABC | Volume 111, Nº1, July 2018

Original Article Wu et al Carotid sinus massage in syncope evaluation Arq Bras Cardiol. 2018; 111(1):84-91 Figure 1 – Magnitudes of the responses of systolic and diastolic blood pressure to a 70° tilt in the symptomatic and asymptomatic groups. Note there is significant fall in the systolic blood pressure (p < 0,001) and diastolic blood pressure (p = 0,001) in the symptomatic group compared with asymptomatic group. 4 2 0 –2 –4 –6 –8 –10 mmHg ∆SBP ∆DBP –9.98 –4.27 –1.29 2.21 Symptomatic Asymptomatic Figure 2 – Results of carotid sinus massage according to the type of response obtained in the symptomatic and asymptomatic groups. CSH: carotid sinus hypersensitivity. 70 60 50 40 30 20 10 0 n no CSH Cardioinhibitory CSH Vasodepressor CSH 67 40 24 17 8 9 Symptomatic Asymptomatic group and 60.6% in the asymptomatic group. Over 32% of the patients in both groups had an abnormal response to CSM, with predominance of CI responses. Men had more abnormal responses to CSM compared to women (53.8% vs. 23.0%, p < 0.001). A predominance of CI response was also observed in men compared to women (43.1% vs. 13.0%). There was no significant difference in responses to CSM related to age. Likewise, no association was observed between CSH and underlying diseases, such as hypertension, diabetes and coronary artery disease (Table 2). There was no difference (Figure 3) in the response to CSM when comparing the decrease in SBP (ΔSBP) and heart rate (ΔRR) between the symptomatic and asymptomatic groups. All patients were in sinus rhythm except for 2 individuals from the symptomatic group, who had atrial fibrillation (AF). One patient had persistent AF, and the other had paroxysmal AF. During the maneuvers, 45 (45.45%) symptomatic patients and 34 (51.5%) asymptomatic patients dropped their SBP to values ≤ 85 mmHg. The proportions of patients who achieved SBP ≤ 85 mmHg in the series of CSM are shown in Table 3. The VD reflex increased from8.0% to 31.3% in the symptomatic group and from 13.6% to 28.7% in the asymptomatic group, when applying the cut-off value of SBP ≤ 85 mmHg for the diagnosis of CSH, compared to the classical blood pressure criteria with a fall in SBP ≥ 50 mmHg. Therefore, the change in the cut-off value increased the diagnosis of CSH by 21.2% (or total 53.5%) and 15.2% (total 54.5%) in the symptomatic and asymptomatic groups, respectively. Although abnormal responses were similar in both groups, symptomatic patients reported more symptoms during CSM (41.4% vs. 27.3%, p = 0.063). The reported symptoms ranged from mild discomfort to syncope. In the symptomatic group, 20 patients reported presyncope, 16 patients reported dizziness, and 3 patients reported nonspecific symptoms. 86