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Background <p>Traditionally, vasovagal syncope (VVS) is thought to result from low blood pressure, causing inadequate cerebral perfusion. However, recent evidence suggests that a decrease in cerebral blood flow may precede a decrease in blood pressure. This study analyzed the clinical characteristics of VVS not due to a drop in blood pressure (primary cerebral autoregulation [CA] dysfunction [PCAD] VVS).</p> Methods <p>A total of 143 patients with VVS underwent a head-up tilt test (HUT) combined with transcranial Doppler (TCD) and were divided into two groups based on whether cerebral blood flow velocity decreased before blood pressure. Demographic information, triggers, symptoms, comorbidities, and hemodynamic indicators were compared between the groups. PCAD accounted for 58% of VVS cases.</p> Results <p>The most common triggers included prolonged standing, strenuous exercise, and urination. The post-syncopal symptoms included sweating/fever, headache/dizziness, and fatigue. Systolic, diastolic, and mean arterial pressures were higher in the PCAD VVS group than in the secondary VVS group at baseline, during nitroglycerin provocation, and after HUT. The PCAD VVS group had a lower prevalence of diabetes and shorter disease duration, with similar sex, age, BMI, and symptoms.</p> Conclusions <p>PCAD VVS is a prevalent subtype with unique clinical features, highlighting the importance of HUT-TCD for an accurate diagnosis.</p>

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Primary cerebral autoregulation dysfunction: a distinct subtype of vasovagal syncope

  • 期刊论文

  • 发表日期：

    2026年3月12日

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  • Meng Hou,
  • Jiarui Wu,
  • Lijie Ren,
  • Cao Liming

摘要

Background

Traditionally, vasovagal syncope (VVS) is thought to result from low blood pressure, causing inadequate cerebral perfusion. However, recent evidence suggests that a decrease in cerebral blood flow may precede a decrease in blood pressure. This study analyzed the clinical characteristics of VVS not due to a drop in blood pressure (primary cerebral autoregulation [CA] dysfunction [PCAD] VVS).

Methods

A total of 143 patients with VVS underwent a head-up tilt test (HUT) combined with transcranial Doppler (TCD) and were divided into two groups based on whether cerebral blood flow velocity decreased before blood pressure. Demographic information, triggers, symptoms, comorbidities, and hemodynamic indicators were compared between the groups. PCAD accounted for 58% of VVS cases.

Results

The most common triggers included prolonged standing, strenuous exercise, and urination. The post-syncopal symptoms included sweating/fever, headache/dizziness, and fatigue. Systolic, diastolic, and mean arterial pressures were higher in the PCAD VVS group than in the secondary VVS group at baseline, during nitroglycerin provocation, and after HUT. The PCAD VVS group had a lower prevalence of diabetes and shorter disease duration, with similar sex, age, BMI, and symptoms.

Conclusions

PCAD VVS is a prevalent subtype with unique clinical features, highlighting the importance of HUT-TCD for an accurate diagnosis.