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Sex-Related Differences in Vasovagal Response Phenotypes During Head-Up Tilt Testing
Session:
Sessão de Posters 17 - O género importa em cardiologia
Speaker:
Raquel França Moreira
Congress:
CPC 2026
Topic:
K. Cardiovascular Disease In Special Populations
Theme:
30. Cardiovascular Disease in Special Populations
Subtheme:
30.2 Cardiovascular Disease in Women
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Raquel França Moreira; Helena Fonseca; Sara Laginha; Pedro Silva Cunha (Phd); Bruno Valente; Guilherme Portugal; Paulo Osório; Sofia Jacinto; Ana Lousinha (Phd); Rui Ferreira; Sérgio Laranjo (Phd); Mário Oliveira (Phd)
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Background</strong>: Sex differences in vasovagal syncope have been reported, but the association with distinct hemodynamic response patterns during head-up tilt testing (HUTT) remains unclear. Since women have higher prevalence and recurrence of syncope, clarifying this relationship is crucial to optimize sex-specific diagnostic and management strategies. This study aimed to assess sex effects over HUTT positivity and response subtypes.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods: </strong>A retrospective single-centre analysis was conducted on 238 consecutive patients undergoing HUTT (62% female, 57±22 years) using standardized Front Loaded (50%) and Fast Italian (50%) protocols. Responses were classified by VASIS (Type 1 mixed, Type 2 cardioinhibitory, or Type 3 vasodepressor). Multivariable logistic regression tested the independent effect of sex on response phenotype among positive tests, adjusting for age and protocol, with inverse probability weighting (IPW) as sensitivity analysis. Follow-up data were available for 150 patients.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results: </strong>Overall, HUTT positivity was 70.5% (165/234) with no significant difference between females and males (73.8% vs 65.2%, p=0.209). Among all patients, males tended to exhibit higher cardioinhibitory rates (18% vs 9%, p=0.068). When analysing positive tests, this difference was significant: cardioinhibitory responses were observed more than twice as often in men than women (27.6% vs 12.1%, p=0.023). After adjustment for age and protocol, male sex remained independently associated with a cardioinhibitory phenotype (OR 2.74, 95% CI 1.15–6.55, p=0.024), confirmed by IPW analysis (OR 2.53, 95% CI 1.10–5.82, p=0.029). Vasodepressor responses were primarily age-dependent (OR 1.04 per year, 95% CI 1.02–1.07, p<0.001), rather than sex-related. Chronotropic incompetence (2.1%), orthostatic hypotension (6.4%), and POTS (2.1%) showed no sex-related differences. Syncope recurrence at one-year follow-up occurred in 22.7% of patients, similar between sexes (25.0% vs 19.0%, p=0.43).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusions: </strong>While overall HUTT positivity rates do not differ between sexes, women predominantly show vasodepressor or mixed vasovagal responses, while men are nearly three times more likely to exhibit cardioinhibitory responses — a finding robust across different analytical approaches. These results suggest sex-specific differences in autonomic modulation during vasovagal episodes, with potential implications for risk stratification and clinical management.</span></span></p>
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