Role of nitric oxide in young patients with vasovagal syncope

Nitric oxide (NO) formed in the vascular endothelium produces, among other effects, a strong vasodilation. In order to evaluate the possible role of NO in hypotension induced by head-up tilt test (HUT), we measured plasma levels of its metabolites, nitrites and nitrates (NOx), during the test.

Twelve patients with vasovagal syncope and positive HUT [HUT(+)] (mean age: 23+/-5 years) and 13 healthy volunteers with negative HUT (controls) (mean age: 24+/-5 years) were included. Venous blood samples were obtained during the baseline stage for biochemical measurements. Plasma values of NOx were obtained under baseline conditions (T0), at the end of the HUT (T1), and 15 min after the end of the HUT (T2). The baseline biochemical values as well as haemodynamic parameters were similar in HUT(+) patients and controls. NOx plasma values (in micromol/L) were as follows [HUT(+) vs. controls]: T0: 5.7+/-1.6 vs. 8.8+/-4.7 (P=0.05), T1: 6.1+/-3.2 vs. 8.5+/-3.6 (P=NS), and T2: 6.1+/-3 vs. 10.2+/-8.9 (P=NS). The NOx levels were directly correlated with the insulin levels (Spearman's R=0.53, P=0.008).

Baseline plasma levels of NOx were significantly lower in HUT(+) patients than in controls. However, since the expected increase in NOx values during HUT-induced syncope was not observed, the possible role of NO in vasovagal hypotension is uncertain.