부산대학교 도서관

Neurally mediated syncope is widely believed to be more common in females (3.5%) than in males (3.0%), but the gender difference has not yet well been evaluated. The aim of this study was to assess the gender difference of clinical manifestations and outcome in patients with suspected neurally mediated syncope. Of 802 consecutive pts referred to our Syncope Unit, 186 pts with structural heart disease or abnormal ECG, 45 with carotid sinus syndrome and 47 pts undergoing only carotid sinus massage were excluded. We studied 524 pts (243 m, 281 f) with normal ECG, absence of heart disease and high likelihood of neurally-mediated syncope. Age at first clinical evaluation (m: mean age 55±20, mode 65, median 60 yrs; f: mean age 54±20, mode 59, median 59 yrs) and co-morbidities (hypertension: 31% m vs 34% f; diabetes: 9% m vs 6% f) were not significantly different between two groups. The median of syncope spells was 2 in both groups, however female pts had more episodes of syncope at first clinical evaluation (m: 2.9±2.7 vs f: 4.3±5.3, p = 0.0001), more traumatic episodes (33% m vs 52% f, p = 0.0001) and major trauma (7% m vs 14% f, p = 0.01). The onset occurred at younger age in female pts (mean age 48±22, mode 16, median 54 yrs) than in male pts (mean age 52±22, mode 38, median 57 yrs) (p = 0.02), with similar age distribution (2 peaks at the ages of 15 to 25 yrs and older than 65 to 70 yrs). The range of duration of syncopal history was 3.1±8.6 yrs in male pts and 6.6±13.7 yrs in female pts (p = 0.001).The clinical presentation at first syncope was suggestive of typical vasovagal syncope in 58% of female pts and 45% of male pts (p = 0.03), situational syncope in 16% of male pts and 9% of female pts (p = 0.04), atypical syncope in 40% of female pts and 33% of male pts (p = n.s.). On follow-up (mean 38±29; complete 98%) 82 pts (39 m, 43 f) had recurrence of syncopal episodes. Severe outcomes (MI, heart failure, stroke) occurred in 42 pts (24 m, 18 f). Overall mortality was 4.9% (6.5% m, 3.5% f). Cumulative event-free curves were similar without significant differences between the two groups. In conclusion the female pts were experiencing syncopal episodes at younger age, for longer periods of their lives and more episodes of syncope, most often with major trauma, than male pts; gender difference was also noted regard to frequency of clinical presentation of the first syncope, most often typical vasovagal syncope in female pts and situational syncope in male pts; on follow-up the recurrence of syncopal episodes was similar between the two groups after accurate education.