Level of cardiovascular adaptations in children with the different types of syncope





children, syncope, cardiovascular adaptations


Clinical studies have shown that syncope is based on a complex sequence of hemodynamic changes which in turn depend on the basic level of functional capabilities of the cardiovascular system and its adaptation mechanisms that determine the intensity and duration of adaptive responses.

Purpose - to determine the level of cardiovascular adaptations in children with syncope; to assess their relationship with some clinical, anamnestic and instrumental parameters.

Materials and methods. A total of 81 children with vasovagal syncope, 25 with syncope due to orthostatic hypotension, 19 with cardiogenic syncope (aged 8-17 years) were included in our study. The control group included 41 healthy children. All patients underwent a clinical and functional examination of the cardiovascular system to determine the level of its adaptative mechanisms.

Results. Children with vasovagal syncope and syncope due to orthostatic hypotension had significantly higher values of cardiac output and systolic blood volume compared to control group (p<0.05), which indicated the intensity of pumping ability of the heart. Children with syncope due to orthostatic hypotension had marked decrease in the efficiency of the heart muscle, as low values of left ventricular rate, circulatory efficiency and cardiac index compared with healthy individuals (p<0.05), as well as the trend to economize hemodynamic responses, as indicated by a significant difference between the values of the Robinson index, a decreased systolic index and the index of functional changes compared with those without syncope (p<0.05). Children with cardiogenic syncope had a significantly reduced the circulatory efficiency coefficient (p<0.05). Significant correlations were detected between the parameters of a series of integrative indicators of the adaptive mechanisms of the cardiovascular system and anamnestic, clinical, and the reports of instrumental studies in children with syncope.

Conclusions. Despite the fact that children with syncope of various types had normal values for most cardiovascular indicators at rest, the tension of pumping capacity of the heart was detected, the efficiency of the cardiac muscle and circulatory efficiency were reduced, which are signs of reduced compensatory responses in children of the study groups determined. The results of the study confirm the close combination of pathogenetic mechanisms of syncope with a decrease in the adaptive mechanisms of the cardiovascular system of this category of patients.

The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institutions mentioned in the work. Informed consent of the children’s parents was obtained for the research.

No conflict of interests was declared by the authors.


Anderson JB, Czosek RJ, Knilans TK, Marino BS. (2012). The effect of paediatric syncope on health-related quality of life. Cardiol Young. 22 (5): 583-538. https://doi.org/10.1017/S1047951112000133; PMid:22348920

Brignole M, Moya A, J de Lange F, Deharo JC, Elliott PM, Fanciulli A, van Dijk JG. (2018). ESC Guidelines for the diagnosis and management of syncope. European Heart Journal. 39 (21): 1883-1948.

Bruss ZS, Raja A. (2021). Physiology, Stroke Volume. Treasure Island (FL): StatPearls Publishing. URL: https://www.ncbi.nlm.nih.gov/books/NBK547686/.

Chang NL, Shah P, Bajaj S, Virk H, Bikkina M, Shamoon F. (2016). Diagnostic Yield of Echocardiography in Syncope Patients with Normal ECG. Cardiol Res Pract: 1251637. URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4736231/. https://doi.org/10.1155/2016/1251637; PMid:26881172 PMCid:PMC4736231

Fedortsiv O, Luchyshyn N. (2013). Physiological adaptation of modern Ukrainian pre-schoolers. Puls Uczelni. 7 (4): 4-9. https://doi.org/10.5604/01.3001.0003.3144

Hajtovych MV. (2014). Diagnostyka arterialnoyi gipertenziyi u ditej ta pidlitkiv. Zdorov'ya Ukrayiny: 38-39.

Huijuan Y, Shuo W, Hong C, Juan Zh, Ping L, Yuwen W, Runmei Z, Cheng W. (2021). Prognostic Value of Biomarkers in Children and Adolescents With Orthostatic Intolerance. Frontiers in Pediatrics. URL: https://www.frontiersin.org/article/10.3389/fped.2021.752123.

Isayeva IM. (2016). Adaptacijni reakciyi sercevo-sudynnoyi systemy v osib molodogo viku z arterialnoyu gipotenziyeyu: avtoref. dys. kand. med. nauk: 14.03.03 L'viv. nacz. med. un-t im. Danyla Galyczkogo: 20.

Kamins'ka OV. (2012). Osoblyvosti adaptaciyi studentiv z osoblyvymy potrebamy do umov navchannya u VNZ. Aktual'ni problemy navchannya ta vyhovannya lyudej z osoblyvymy potrebamy. 9: 75-84.

Kim H, Eun LY. (2021). Assessment of cardiac function in syncopal children without organic causes. Clin Exp Pediatr. 64 (11): 582-587. https://doi.org/10.3345/cep.2019.01046; PMid:33705633 PMCid:PMC8566802

Kocz SM, Kocz VP. (2019). Doslidzhennya funkcional'nogo stanu sercevo-sudynnoyi systemy ditej shkil'nogo viku. Al'manax nauky. 11/1 (32): 4-7.

Kovalchuk ТA, Pavlyshyn HA, Boyarchuk OR, Luchyshyn NY. (2019). Analysis of heart rate variability in paediatric patients with vasovagal syncope. Pediatria Polska. 94 (6): 357-367.

Kvashnina LV, Makovkina YuA. (2005). Svoyechasna diagnostyka zdorovya ditej: ocinka adaptacijnyh mozhlyvostej. Mystecztvo likuvannya. 10: 28-30. https://doi.org/10.1016/j.asthmamag.2005.02.008

Malikov MV, Svat'yev AV, Bohdanovs'ka NV. (2006). Funktsional'na diahnostyka u fizychnomu vykhovanni i sporti: Navchal'nyy posibnyk dlya studentiv vyshchykh navchal'nykh zakladiv. Zaporizhzhya: ZDU: 227.

Marushko YuV, Gyshhak TV. (2014). Systemni mexanizmy adaptaciyi. Stres u ditej. Kyiv: 158.

McCarthy K, Ward M, Romero Ortuño R, Kenny RA. (2020). Syncope, Fear of Falling and Quality of Life Among Older Adults: Findings From the Irish Longitudinal Study on Aging (TILDA). Front Cardiovasc Med: 7. https://doi.org/10.3389/fcvm.2020.00007; PMid:32118045 PMCid:PMC7020746

Michael D. (2009). Gammage, Impact of syncope on quality of life: do we need another tool? EP Europace. 11 (10): 1265-1266. https://doi.org/10.1093/europace/eup147; PMid:19797145

Myhajlovs'ka NS, Kulynych TO, Stecyuk IO, Antypenko OO. (2020). Osnovni pryncypy diagnostyky ta likuvannya zahvoryuvan' dyhal'noyi ta sercevo-sudynnoyi systemy v klinici vnutrishnih xvorob: navch. posib. dlya zdobuvachiv stupenya d-ra filosofiyi za tretim osvitn'o-naukovym rivnem za programoyu navch. dyscz. Suchasni aspekty vyvchennya vnutrishnih hvorob. Zaporizhzhya: ZDMU: 38.

Nechytailo DYu, Miheeva TM, Kovtyuk NI. (2019). Osoblyvosti funkcional'nyh prob sercevo-sudynnoyi systemy u ditej z pidvyshhenym rivnem arterialnogo tysku. Bukovyns'kyj medychnyj visnyk. 23,4 (92): 86-92. https://doi.org/10.24061/2413-0737.XXIII.4.92.2019.94

Patel N, Durland J, Makaryus AN. (2021). Physiology, Cardiac Index. In: StatPearls https://www.ncbi.nlm.nih.gov/books/NBK539905/.

Pavlyshyn GA, Fedortsiv OYe, Luchyshyn NYu, Kovalchuk TA. (2012). Funkcional'nyj stan sercevo-sudynnoyi systemy yak faktor adaptaciyi ditej doshkil'nogo viku. Mezhdunarodnyj zhurnal pedyatryy, akusherstva y gynekologiyi. 2 (3): 42-45.

Rose MFL da Silva. (2014). Syncope: epidemiology, etiology, and prognosis. Front Physiol. 5: 471. https://doi.org/10.3389/fphys.2014.00471; PMid:25538626 PMCid:PMC4258989

Winder MM, Marietta J, Kerr LM, Puchalski MD, Zhang C, Ware AL, Cowley CG. (2021). Reducing Unnecessary Diagnostic Testing in Pediatric Syncope: A Quality Improvement Initiative. Pediatr Cardiol. 42 (4): 942-950. https://doi.org/10.1007/s00246-021-02567-4; PMid:33582873 PMCid:PMC8805737

Zou R, Wang S, Zhu L, Wu L, Lin P, Li F, Xie Z, Li X, Wang C. (2017). Calgary score and modified Calgary score in the differential diagnosis between neurally mediated syncope and epilepsy in children. Neurological sciences. 38 (1): 143-149. https://doi.org/10.1007/s10072-016-2740-5; PMid:27747448





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