Jugular venous reflux and plasma endothelin-1 are associated with cough syncope: A case control pilot study

Chih Ping Chung, Chun Yu Cheng, Robert Zivadinov, Wei Chih Chen, Wen Yung Sheng, Yu Chin Lee, Han Hwa Hu, Hung Yi Hsu, Kuang Yao Yang

Research output: Contribution to journalArticle

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Abstract

Background: Jugular venous reflux (JVR) has been reported to cause cough syncope via retrograde-transmitted venous hypertension and consequently decreased cerebral blood flow (CBF). Unmatched frequencies of JVR and cough syncope led us to postulate that there should be additional factors combined with JVR to exaggerate CBF decrement during cough, leading to syncope. The present pilot study tested the hypothesis that JVR, in addition to an increased level of plasma endothelin-1 (ET-1), a potent vasoconstrictor, is involved in the pathophysiology of cough syncope. Methods: Seventeen patients with cough syncope or pre-syncope (Mean[SD] = 74.63(12.37) years; 15 males) and 51 age/gender-matched controls received color-coded duplex ultrasonography for JVR determination and plasma ET-1 level measurements.Results: Multivariate logistic analysis showed that the presence of both-side JVR (odds ratio [OR] = 10.77, 95% confident interval [CI] = 2.40-48.35, p = 0.0019) and plasma ET-1 > 3.43 pg/ml (OR = 14.57, 95% CI = 2.95-71.59, p = 0.001) were independently associated with the presence of cough syncope/ pre-syncope respectively. There was less incidence of cough syncope/ pre-syncope in subjects with the absence of both-side JVR and a plasma ET-1 ≦3.43 pg/ml. Presence of both side JVR and plasma ET-1 level of > 3.43 pg/ml, increased risk for cough syncope/pre-syncope (p < 0.001). Conclusions: JVR and higher plasma levels of ET-1 are associated with cough syncope/ pre-syncope. Although sample size of this study was small, we showed a synergistic effect between JVR and plasma ET-1 levels on the occurrence of cough syncope/pre-syncope. Future studies should confirm our pilot findings.

Original languageEnglish
Article number9
JournalBMC Neurology
Volume13
DOIs
Publication statusPublished - Jan 16 2013
Externally publishedYes

Fingerprint

Syncope
Endothelin-1
Cough
Case-Control Studies
Neck
Cerebrovascular Circulation
Odds Ratio
Vasoconstrictor Agents
Sample Size

Keywords

  • Cough syncope
  • Endothelin-1
  • Jugular venous reflux

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Chung, C. P., Cheng, C. Y., Zivadinov, R., Chen, W. C., Sheng, W. Y., Lee, Y. C., ... Yang, K. Y. (2013). Jugular venous reflux and plasma endothelin-1 are associated with cough syncope: A case control pilot study. BMC Neurology, 13, [9]. https://doi.org/10.1186/1471-2377-13-9

Jugular venous reflux and plasma endothelin-1 are associated with cough syncope : A case control pilot study. / Chung, Chih Ping; Cheng, Chun Yu; Zivadinov, Robert; Chen, Wei Chih; Sheng, Wen Yung; Lee, Yu Chin; Hu, Han Hwa; Hsu, Hung Yi; Yang, Kuang Yao.

In: BMC Neurology, Vol. 13, 9, 16.01.2013.

Research output: Contribution to journalArticle

Chung, Chih Ping ; Cheng, Chun Yu ; Zivadinov, Robert ; Chen, Wei Chih ; Sheng, Wen Yung ; Lee, Yu Chin ; Hu, Han Hwa ; Hsu, Hung Yi ; Yang, Kuang Yao. / Jugular venous reflux and plasma endothelin-1 are associated with cough syncope : A case control pilot study. In: BMC Neurology. 2013 ; Vol. 13.
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AU - Zivadinov, Robert

AU - Chen, Wei Chih

AU - Sheng, Wen Yung

AU - Lee, Yu Chin

AU - Hu, Han Hwa

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N2 - Background: Jugular venous reflux (JVR) has been reported to cause cough syncope via retrograde-transmitted venous hypertension and consequently decreased cerebral blood flow (CBF). Unmatched frequencies of JVR and cough syncope led us to postulate that there should be additional factors combined with JVR to exaggerate CBF decrement during cough, leading to syncope. The present pilot study tested the hypothesis that JVR, in addition to an increased level of plasma endothelin-1 (ET-1), a potent vasoconstrictor, is involved in the pathophysiology of cough syncope. Methods: Seventeen patients with cough syncope or pre-syncope (Mean[SD] = 74.63(12.37) years; 15 males) and 51 age/gender-matched controls received color-coded duplex ultrasonography for JVR determination and plasma ET-1 level measurements.Results: Multivariate logistic analysis showed that the presence of both-side JVR (odds ratio [OR] = 10.77, 95% confident interval [CI] = 2.40-48.35, p = 0.0019) and plasma ET-1 > 3.43 pg/ml (OR = 14.57, 95% CI = 2.95-71.59, p = 0.001) were independently associated with the presence of cough syncope/ pre-syncope respectively. There was less incidence of cough syncope/ pre-syncope in subjects with the absence of both-side JVR and a plasma ET-1 ≦3.43 pg/ml. Presence of both side JVR and plasma ET-1 level of > 3.43 pg/ml, increased risk for cough syncope/pre-syncope (p < 0.001). Conclusions: JVR and higher plasma levels of ET-1 are associated with cough syncope/ pre-syncope. Although sample size of this study was small, we showed a synergistic effect between JVR and plasma ET-1 levels on the occurrence of cough syncope/pre-syncope. Future studies should confirm our pilot findings.

AB - Background: Jugular venous reflux (JVR) has been reported to cause cough syncope via retrograde-transmitted venous hypertension and consequently decreased cerebral blood flow (CBF). Unmatched frequencies of JVR and cough syncope led us to postulate that there should be additional factors combined with JVR to exaggerate CBF decrement during cough, leading to syncope. The present pilot study tested the hypothesis that JVR, in addition to an increased level of plasma endothelin-1 (ET-1), a potent vasoconstrictor, is involved in the pathophysiology of cough syncope. Methods: Seventeen patients with cough syncope or pre-syncope (Mean[SD] = 74.63(12.37) years; 15 males) and 51 age/gender-matched controls received color-coded duplex ultrasonography for JVR determination and plasma ET-1 level measurements.Results: Multivariate logistic analysis showed that the presence of both-side JVR (odds ratio [OR] = 10.77, 95% confident interval [CI] = 2.40-48.35, p = 0.0019) and plasma ET-1 > 3.43 pg/ml (OR = 14.57, 95% CI = 2.95-71.59, p = 0.001) were independently associated with the presence of cough syncope/ pre-syncope respectively. There was less incidence of cough syncope/ pre-syncope in subjects with the absence of both-side JVR and a plasma ET-1 ≦3.43 pg/ml. Presence of both side JVR and plasma ET-1 level of > 3.43 pg/ml, increased risk for cough syncope/pre-syncope (p < 0.001). Conclusions: JVR and higher plasma levels of ET-1 are associated with cough syncope/ pre-syncope. Although sample size of this study was small, we showed a synergistic effect between JVR and plasma ET-1 levels on the occurrence of cough syncope/pre-syncope. Future studies should confirm our pilot findings.

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