ABSTRACT
BACKGROUND: Cardioneuroablation (CNA) has shown encouraging results in patients with vasovagal syncope (VVS). However, data on different subtypes was scarce. METHODS: This observational study retrospectively enrolled 141 patients [mean age: 40 ± 18 years, 51 males (36.2%)] with the diagnosis of VVS. The characteristics among different types of VVS and the outcomes after CNA were analyzed. RESULTS: After a mean follow-up of 4.3 ± 1.5 years, 41 patients (29.1%) experienced syncope/pre-syncope events after CNA. Syncope/pre-syncope recurrence significantly differed in each subtype (P = 0.04). The cardioinhibitory type of VVS had the lowest recurrence rate after the procedure (n = 6, 16.7%), followed by mixed (n = 26, 30.6%) and vasodepressive (n = 9, 45.0%). Additionally, a significant difference was observed in the analyses of the Kaplan-Meier survival curve (P = 0.02). Syncope/pre-syncope burden was significantly reduced after CNA in the vasodepressive type (P < 0.01). Vasodepressive types with recurrent syncope/pre-syncope after CNA have a lower baseline deceleration capacity (DC) level than those without (7.4 ± 1.0 ms vs. 9.0 ± 1.6 ms, P = 0.01). Patients with DC < 8.4 ms had an 8.1 (HR = 8.1, 95% CI: 2.2-30.0, P = 0.02) times risk of syncope/pre-syncope recurrence after CNA compared to patients with DC ≥ 8.4 ms, and this association still existed after adjusting for age and sex (HR = 8.1, 95% CI: 2.2-30.1, P = 0.02). CONCLUSIONS: Different subtypes exhibit different event-free rates. The vasodepressive type exhibited the lowest event-free rate, but those patients with DC ≥ 8.4 ms might benefit from CNA.
ABSTRACT
As there is no clear biomarker to diagnose Parkinson's disease, this meta-analysis aims to comprehensively evaluates the correlation between serum Cystatin C levels and Parkinson's disease in the Chinese population by the meta-analysis method. PubMed, Web of Science, Embase, Cochrane Library, China national knowledge infrastructure, and China WanFang databases were systematically searched on the correlation between serum Cystatin C and Parkinson's disease. The results showed that Cystatin C level in Parkinson's disease patients compared with the control group, the standardized mean difference = 1.78 (95% CI: 1.33~2.24, P < 0.05). The level of Cystatin C in the late Parkinson's disease stage compared with that in the mid-term of Parkinson's disease, the standardized mean difference was = 0.78 (95% CI: 0.08~1.49, P < 0.05). The Cystatin C level in the mid-term of Parkinson's disease compared with that in the early Parkinson's disease stage, the standardized mean difference was 1.24 (95% CI: 0.35~2.12, P < 0.05). The level of Cystatin C in Parkinson's disease with mild cognitive impairment compared with Parkinson's disease without mild cognitive impairment, the standardized mean difference was 1.29 (95% CI: 0.47~2.10, P < 0.05). The differences were all statistically significant. In conclusion, a high level of serum Cystatin C may be involved in the occurrence and development of Parkinson's disease, whose level is higher in Parkinson's disease patients with mild cognitive impairment than that in Parkinson's disease without mild cognitive impairment. Therefore, Cystatin C in serum is a promising biomarker for diagnosing Parkinson's disease.