Investigating cardiovascular and cerebrovascular variability in postural syncope by means of extended Granger causality

The patterns of Granger causality (GC) between heart period (HP), mean arterial pressure (AP) and cerebral blood flow velocity (FV) were investigated in ten subjects with postural related syncope (PRS). The classic GC measure based on vector autoregressive (VAR) modeling was compared with a novel extended GC (eGC) measure derived from VAR models incorporating instantaneous causal effects among the series. The analysis was performed in the supine and in the upright position during early (ET) and late (LT, close to presyncope) epochs of head-up tilt. Moving from ET to LT, both GC and eGC decreased from AP to HP, and increased from AP to FV, reflecting baroreflex impairment and loss of cerebral autoregulation. The statistical significance of these changes was better assessed using the eGC, thus suggesting the importance of including instantaneous effects in the causality analysis of cardiovascular and cerebrovascular variability during PRS.