Tissue oximetry for the diagnosis of neurally mediated syncope

This study examined the potential clinical contribution of noninvasive brain and skeletal muscle oximetry as a diagnostic aid in neurally mediated syncope. Tilt table testing was performed in 15 patients with a history of syncope and 9 healthy volunteers. Spatially resolved reflectance near-infrared spectroscopy was used to examine regional oxyhemoglobin saturation in the frontal cerebral cortex and pectoral muscle. During upright tilt, syncope occurred in four patients. Each episode was associated with bradycardia, hypotension, and brain oxygen desaturation of > 20% from the supine reference baseline, while the largest desaturation in nonsyncopal patients was 13%. In two syncopal patients, a sudden increase in pectoral oxygen saturation preceded cerebral oxygen desaturation and unconsciousness, suggesting a sudden loss of peripheral sympathetic tone. Simultaneous desaturation in both tissues in the other two patients appeared to be in response to a diminished cardiac output. The muscle and brain oxygen saturation ratio increased by 75% with apparent sympathetic dysfunction, but never changed by > 25% in the other patients, and varied by < 15% in the volunteers. These results suggest that during tilt table testing, simultaneous assessment of brain and skeletal muscle oxygenation may provide a simple, objective aid for the identification of contributory sympathetic dysfunction.