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Vasovagal Syncope Is Associated with Variants in Genes Involved in Neurohumoral Signaling Pathways. Genes (Basel) 2022; 13:genes13091653. [PMID: 36140820 PMCID: PMC9498630 DOI: 10.3390/genes13091653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 11/25/2022] Open
Abstract
Vasovagal syncope (VVS) is the most common cause of sudden loss of consciousness. VVS results from cerebral hypoperfusion, due to abnormal autonomic control of blood circulation, leading to arterial hypotension. It is a complex disease, and its development is largely associated with genetic susceptibility. Since abnormal neurohumoral regulation plays an important role in VVS development, we analyzed the association of VVS with polymorphic variants of ADRA1A, ADRB1, HTR1A, ADORA2A, COMT, and NOS3 genes, the products of which are involved in neurohumoral signaling, in patients with a confirmed VVS diagnosis (157 subjects) and individuals without a history of syncope (161 subjects). We were able to identify the associations between VVS and alleles/genotypes ADRA1A rs1048101, ADRB1 rs1801253, ADORA2A rs5751876, and COMT rs4680, as well as NOS3 rs2070744 in biallelic combination with COMT rs4680. Thus, we are the first to observe, within a single study, the role of the genes that encode α- and β-adrenergic receptors, catechol-O-methyltransferase, adenosine receptors and nitric oxide synthase in VVS development. These findings demonstrate that the genes involved in neurohumoral signaling pathways contribute to the formation of a genetic susceptibility to VVS.
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Genetic Analysis of Cardiac Syncope-Related Genes in Korean Patients with Recurrent Neurally Mediated Syncope. J Cardiovasc Dev Dis 2022; 9:jcdd9080265. [PMID: 36005429 PMCID: PMC9409957 DOI: 10.3390/jcdd9080265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/09/2022] [Accepted: 08/11/2022] [Indexed: 11/17/2022] Open
Abstract
Neurally mediated syncope (NMS) is a common clinical problem. The underlying genetic factors of NMS remain controversial. We hypothesized that cardiac syncope-related genes may contribute to NMS in patients with previous frequent syncopal episodes and/or a family history of syncope. A total of 54 consecutive patients diagnosed with NMS were prospectively enrolled between 2013 and 2016. Inclusion criteria were more than five syncopal episodes with a family history of syncope (n = 17) or more than five syncopal episodes with no family history of syncope (n = 37). Ninety-eight cardiac syncope-related genes (channelopathy: 43 genes, cardiomyopathy: 50 genes, primary pulmonary hypertension: 5 genes) were screened by exome sequencing. All identified variants were classified according to the standards and guidelines by the American College of Medical Genetics and Genomics and the Association for Molecular Pathology. Of the 54 patients, 17 patients (31.5%) had a family history of syncope. Two patients (3.7%) had pathogenic and likely pathogenic variants (PV/LPV) in cardiac syncope-related genes TTN and MYH7. We investigated genetic variation in patients with frequent NMS with a positive family history of syncope in Korea. PV/LPVs in genes related to cardiomyopathy were associated with recurrent NMS in Korean patients. Closer follow-up of these patients might be needed.
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Matveeva N, Titov B, Bazyleva E, Pevzner A, Favorova O. Towards Understanding the Genetic Nature of Vasovagal Syncope. Int J Mol Sci 2021; 22:10316. [PMID: 34638656 PMCID: PMC8508958 DOI: 10.3390/ijms221910316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 09/21/2021] [Accepted: 09/23/2021] [Indexed: 11/17/2022] Open
Abstract
Syncope, defined as a transient loss of consciousness caused by transient global cerebral hypoperfusion, affects 30-40% of humans during their lifetime. Vasovagal syncope (VVS) is the most common cause of syncope, the etiology of which is still unclear. This review summarizes data on the genetics of VVS, describing the inheritance pattern of the disorder, candidate gene association studies and genome-wide studies. According to this evidence, VVS is a complex disorder, which can be caused by the interplay between genetic factors, whose contribution varies from monogenic Mendelian inheritance to polygenic inherited predisposition, and external factors affecting the monogenic (resulting in incomplete penetrance) and polygenic syncope types.
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Affiliation(s)
- Natalia Matveeva
- National Medical Research Center for Cardiology, 121552 Moscow, Russia; (N.M.); (B.T.); (E.B.); (A.P.)
- Department of Molecular Biology and Medical Biotechnology, Pirogov Russian National Research Medical University, 117997 Moscow, Russia
| | - Boris Titov
- National Medical Research Center for Cardiology, 121552 Moscow, Russia; (N.M.); (B.T.); (E.B.); (A.P.)
- Department of Molecular Biology and Medical Biotechnology, Pirogov Russian National Research Medical University, 117997 Moscow, Russia
| | - Elizabeth Bazyleva
- National Medical Research Center for Cardiology, 121552 Moscow, Russia; (N.M.); (B.T.); (E.B.); (A.P.)
| | - Alexander Pevzner
- National Medical Research Center for Cardiology, 121552 Moscow, Russia; (N.M.); (B.T.); (E.B.); (A.P.)
| | - Olga Favorova
- National Medical Research Center for Cardiology, 121552 Moscow, Russia; (N.M.); (B.T.); (E.B.); (A.P.)
- Department of Molecular Biology and Medical Biotechnology, Pirogov Russian National Research Medical University, 117997 Moscow, Russia
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Sheldon RS, Gerull B. Genetic markers of vasovagal syncope. Auton Neurosci 2021; 235:102871. [PMID: 34474354 DOI: 10.1016/j.autneu.2021.102871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 08/10/2021] [Accepted: 08/22/2021] [Indexed: 12/18/2022]
Abstract
Vasovagal syncope may have a genetic predisposition. It has a high prevalence in some families, and children of a fainting parent are more likely to faint than those without a parent who faints. Having two fainting parents or a fainting twin increases the likelihood even further. Several genotypes appear to associate with the phenotype of positive tilt tests, but the control subjects are usually those who faint and have negative tilt tests. Twin studies, highly focused genome-wide association studies, and copy number variation studies all suggest there are loci in the genome that associate with vasovagal syncope, although the specific genes, pathways, and proteins are unknown. A recent multigenerational kindred candidate gene study identified 3 genes that associate with vasovagal syncope. The best evidence to date is for central signaling genes involving serotonin and dopamine. Genome-wide association studies to date have not yet been helpful. Our understanding of the genetic correlates of vasovagal syncope leaves ample opportunity for future work.
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Affiliation(s)
- Robert S Sheldon
- Libin Cardiovascular Institute, University of Calgary, Calgary, Canada; Department of Internal Medicine I and Comprehensive Heart Failure Center, University of Würzburg, Germany.
| | - Brenda Gerull
- Libin Cardiovascular Institute, University of Calgary, Calgary, Canada; Department of Internal Medicine I and Comprehensive Heart Failure Center, University of Würzburg, Germany
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Alboni P, Messop AC, Lauri A, Furlan R. Are women really more affected by vasovagal syncope than men? J Cardiovasc Med (Hagerstown) 2021; 22:69-78. [PMID: 32925389 DOI: 10.2459/jcm.0000000000001009] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
It is commonly reported that vasovagal syncope (VVS) is more frequent in women. Presently, this issue has never been investigated. The purpose of this review was to evaluate, through an extensive review of the literature, whether women are really more affected by VVS than men. The gender distribution was investigated in individuals with classical and nonclassical VVS. The database PubMed was searched using the terms 'syncope', 'vasovagal syncope', 'neurally mediated syncope' and 'tilt testing'. Twelve studies dealing with classical and 75 with nonclassical VVS were eligible. In the individuals with classical (N = 1861) and nonclassical VVS (N = 9696), a trend towards a greater percentage of women emerged (P = 0.14 and 0.07, respectively). In the total population with VVS (N = 11 557), the percentage of women was significantly higher than that of men (58 versus 42%, P = 0.03). Most of the individuals were young or middle-aged. In 84% of the studies, the percentage of women was greater than that of men. A separate analysis was carried out in older VVS patients (≥60 years) and only two studies were eligible to be evaluated. Considering that almost all the studies were carried out in the western nations, where the number of men and women is almost superimposable until the age of 65 years and a bias by gender has never been reported in the management of VVS, these data strongly suggest that young and middle-aged women are more affected by VVS than their male counterparts. At present, data are too scant to draw a definitive conclusion in older VVS patients.
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Affiliation(s)
| | | | - Alessandro Lauri
- Section of Economics and Statistics, Ospedale Privato Quisisana, Ferrara
| | - Raffaello Furlan
- Internal Medicine, Humanitas Clinical and Research Center, IRCCS, Humanitas University, Rozzano, Italy
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Syncope in Malaysian populations. Clin Auton Res 2020; 30:101-103. [DOI: 10.1007/s10286-019-00663-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 12/25/2019] [Indexed: 10/25/2022]
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Sheldon RS, Sandhu RK. The Search for the Genes of Vasovagal Syncope. Front Cardiovasc Med 2019; 6:175. [PMID: 31850372 PMCID: PMC6892747 DOI: 10.3389/fcvm.2019.00175] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 11/14/2019] [Indexed: 11/29/2022] Open
Abstract
Only humans faint, and not all do so. Syncope tends to recur, and the predisposition to syncope can persist over many decades. Observations such as these have suggested that there may be a genetic predisposition to vasovagal syncope. It seems to have a high prevalence in some families; having a parent who faints increases the likelihood of an offspring fainting, and this is increased even further if both biological parents faint. Numerous studies have correlated a number of genotypes with positive tilt tests. However, the control subjects are usually those who faint, but have negative tilt tests, making the conclusions about association with the clinical phenotype less certain. Twin studies, highly focused genome-wide association studies, and gene duplicate studies all suggest there are sites in the genome that associate with vasovagal syncope, although the specific genes, pathways, and proteins are unknown. A recent large, candidate gene study of kindreds with high, multigenerational prevalence of the vasovagal syncope identified 3 genes that associate with vasovagal syncope. Our understanding of the genetic correlates of vasovagal syncope is in its infancy, with much to be understood.
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Affiliation(s)
- Robert S Sheldon
- The Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada.,The Mazankowski Heart Institute, University of Alberta, Edmonton, AB, Canada
| | - Roopinder K Sandhu
- The Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada.,The Mazankowski Heart Institute, University of Alberta, Edmonton, AB, Canada
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Sheldon R, Rose MS, Ritchie D, Martens K, Maxey C, Jagers J, Parboosingh J, Gerull B. Genetic Association Study in Multigenerational Kindreds With Vasovagal Syncope: Evidence for Involvement of Sex-Specific Serotonin Signaling. Circ Arrhythm Electrophysiol 2019; 12:e006884. [PMID: 30636478 DOI: 10.1161/circep.118.006884] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Several studies suggest that vasovagal syncope has a genetic origin, but this is unclear. We assessed whether plausible gene variants associate with vasovagal syncope. METHODS We studied 160 subjects in 9 kindreds comprising 82 fainters and 78 controls. The diagnosis was ascertained with the Calgary Syncope Score. Common genetic variants were genotyped for 12 genes for vascular signaling, potassium channels, the HTR1A(serotonin 5-HT1A receptor), SLC6A4(serotonin reuptake transporter), and COMT(catecholamine O-methyltransferase). Sex-specific associations between genotypes and phenotypes were tested. RESULTS In 9 out of 12 variants, there was no significant association between genotype and phenotype. However, the HTR1A(-1019) G alleles associated with syncope in males, but not in females ( P=0.005). CC and GG males had 9% versus 77% likelihoods of syncope. The SLC6A4 promoter L alleles associated with decreased syncope in males but increased in females ( P=0.059). The LL and SS males had 25% and 47% syncope likelihoods, whereas females had 75% and 50% syncope likelihoods. The COMT c.472 A alleles associated with decreased syncope in males but increased in females ( P=0.017). The GG and AA males had 50% and 15% syncope likelihoods, whereas females had 52% and 73% syncope likelihoods. CONCLUSIONS There is a sex-dependent effect of alleles of serotonin signaling and vasovagal syncope, supporting the serotonin hypothesis of the physiology of vasovagal syncope.
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Affiliation(s)
- Robert Sheldon
- Libin Cardiovascular Institute of Calgary, Alberta, Canada (R.S., M.S.R., D.R., K.M., C.M., J.J., B.G.)
| | - M Sarah Rose
- Libin Cardiovascular Institute of Calgary, Alberta, Canada (R.S., M.S.R., D.R., K.M., C.M., J.J., B.G.)
| | - Debbie Ritchie
- Libin Cardiovascular Institute of Calgary, Alberta, Canada (R.S., M.S.R., D.R., K.M., C.M., J.J., B.G.)
| | - Kristina Martens
- Libin Cardiovascular Institute of Calgary, Alberta, Canada (R.S., M.S.R., D.R., K.M., C.M., J.J., B.G.)
| | - Connor Maxey
- Libin Cardiovascular Institute of Calgary, Alberta, Canada (R.S., M.S.R., D.R., K.M., C.M., J.J., B.G.)
| | - Jennie Jagers
- Libin Cardiovascular Institute of Calgary, Alberta, Canada (R.S., M.S.R., D.R., K.M., C.M., J.J., B.G.)
| | - Jillian Parboosingh
- Alberta Children's Hospital Research Institute, University of Calgary, Canada (J.P.)
| | - Brenda Gerull
- Libin Cardiovascular Institute of Calgary, Alberta, Canada (R.S., M.S.R., D.R., K.M., C.M., J.J., B.G.).,Department Kardiovasculare Genetik, University Hospital Würzburg and University Würzburg, Germany (B.G.)
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Feng S, Li N, Xu S, Wang H, Yu W, Lu Y, Cao J, Meng Y. Association of ADRB1 gene polymorphisms with pain sensitivity in a Chinese population. Int J Clin Exp Med 2015; 8:11514-11518. [PMID: 26379972 PMCID: PMC4565355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 04/03/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The present study aims to observe the influence of single-nucleotide polymorphisms (SNPs) in the ADRB1 gene on individual differences in pain sensitivity. METHODS We analyzed the associations between pain sensitivity and ADRB1 gene SNPs (A145 G and G1165 C) in 324 Chinese patients who underwent surgery. The genotyping was performed using PCR-RFLP technique. RESULTS The patients who carried the A-allele of the A145 G SNP were more sensitive to cold pressor-induced pain than those who did not carry this allele (P < 0.05). We did not found G1165 C polymorphism associated with pain sensitive in the present study. The haplotype analysis revealed A-C haplotype carriers have reduced fentanyl use in 24-h postoperative (P < 0.05). CONCLUSION ADRB1 gene polymorphisms are associated with pain and analgesic sensitivity.
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Affiliation(s)
- Shuang Feng
- Department of Radiotherapy, Eastern Hepatobiliary Surgery Hospital, Second Military Medical UniversityShanghai 200438, China
| | - Nan Li
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical UniversityShanghai 200438, China
| | - Sheng Xu
- Department of Radiotherapy, Eastern Hepatobiliary Surgery Hospital, Second Military Medical UniversityShanghai 200438, China
| | - Hao Wang
- Department of Radiotherapy, Eastern Hepatobiliary Surgery Hospital, Second Military Medical UniversityShanghai 200438, China
| | - Wei Yu
- Department of Radiotherapy, Eastern Hepatobiliary Surgery Hospital, Second Military Medical UniversityShanghai 200438, China
| | - Yan Lu
- Department of Radiotherapy, Eastern Hepatobiliary Surgery Hospital, Second Military Medical UniversityShanghai 200438, China
| | - Jianping Cao
- School of Radiation Medicine and Protection, Soochow UniversitySuzhou, China
| | - Yan Meng
- Department of Radiotherapy, Eastern Hepatobiliary Surgery Hospital, Second Military Medical UniversityShanghai 200438, China
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Koźluk E, Cybulski G, Piątkowska A, Zastawna I, Niewiadomski W, Strasz A, Gąsiorowska A, Kempa M, Kozłowski D, Opolski G. Early hemodynamic response to the tilt test in patients with syncope. Arch Med Sci 2014; 10:1078-85. [PMID: 25624842 PMCID: PMC4296066 DOI: 10.5114/aoms.2014.47820] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 05/25/2013] [Accepted: 10/02/2013] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Our aim was to evaluate the differences in the early hemodynamic response to the tilt test (HUTT) in patients with and without syncope using impedance cardiography (ICG). MATERIAL AND METHODS One hundred twenty-six patients (72 female/48 male; 37 ±17 years) were divided into a group with syncope (HUTT(+), n = 45 patients) and a group without syncope (HUTT(-), n = 81 patients). ECG and ICG signals were continuously recorded during the whole examination, allowing the calculation of heart rate (HR), stroke volume (SV), and cardiac output (CO) for every beat. The hemodynamic parameters (averaged over 1 min) were analyzed at the following points of the HUTT: the last minute of resting, the period immediately after the tilt (0 min), 1 min and 5 min after the maneuver. The absolute changes of HR, SV and CO were calculated for 0, 1, and 5 min after the maneuver in relation to the values at rest (ΔHR, ΔSV, ΔCO). Also, the percentage changes were calculated (HRi, SVi, COi). RESULTS There were no differences between the groups in absolute and percentage changes of hemodynamic parameters immediately after and 1 min after tilting. Significant differences between the HUTT(+) and HUTT(-) groups were observed in the 5(th) min of tilting: for ΔSV (-27.2 ±21.2 ml vs. -9.7 ±27.2 ml; p = 0.03), ΔCO (-1.78 ±1.62 l/min vs. -0.34 ±2.48 l/min; p = 0.032), COi (-30 ±28% vs. -0.2 ±58%; p = 0.034). CONCLUSIONS In the 5(th) min the decrease of hemodynamic parameters (ΔSV, ΔCO, COi) was significantly more pronounced in HUTT(+) patients in comparison to the HUTT(-) group.
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Affiliation(s)
- Edward Koźluk
- Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Gerard Cybulski
- Department of Applied Physiology, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
- Institute of Metrology and Biomedical Engineering, Department of Mechatronics, Warsaw University of Technology, Warsaw, Poland
| | - Agnieszka Piątkowska
- Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Inga Zastawna
- Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
- Department and Clinic of Cardiac Rehabilitation and Noninvasive Electrocardiology, The Cardinal Stefan Wyszynski Institute of Cardiology, Warsaw, Poland
| | - Wiktor Niewiadomski
- Department of Applied Physiology, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
- Chair and Department of Experimental and Clinical Physiology, Medical University of Warsaw, Warsaw, Poland
| | - Anna Strasz
- Department of Applied Physiology, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | - Anna Gąsiorowska
- Department of Applied Physiology, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | - Maciej Kempa
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Dariusz Kozłowski
- Department of Clinical Subjects, Institute of Health Sciences, Pomeranian University of Slupsk, Slupsk, Poland
| | - Grzegorz Opolski
- Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
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