Clinical findings as predictors of positivity of head-up tilt table test in neurocardiogenic syncope

Asensio, Enrique; Oseguera, Jorge; Lorı́a, Alvar; Gómez, María Josefa Montero; Narvaez, R. Byron; Dorantes, Joel; Hernández, Pablo; Orea, Arturo; Rebollar, Verónica; Ocaranza, Raymundo

doi:10.1016/s0188-4409(03)00046-8

Cited by 13 publications

(8 citation statements)

References 21 publications

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“…These data reinforce the usefulness of the medical history and a directed interrogation. The combination of symptoms such as nausea, dizziness and diaphoresis had already been studied and it was found to have a good correlation with the HUTT result [10]. In this group, such a behavior is reproduced and that is why it was included in the regression analysis.…”

Section: Discussionmentioning

confidence: 91%

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Ambulatory postural blood pressure changes and history allow a better selection of patients that should undergo a head-up tilt test

Asensio

Lecuna

Castro³

et al. 2015

Cardiol J

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Section: Discussionmentioning

confidence: 91%

“…On the other hand, several studies have tried to make an early prediction of the head-up tilt table test (HUTT) result, nevertheless, the results remain contradictory and there is no single measurement or combination that are able to predict the HUTT's result with precision [8][9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Ambulatory postural blood pressure changes and history allow a better selection of patients that should undergo a head-up tilt test

Asensio

Lecuna

Castro³

et al. 2015

Cardiol J

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“…Many studies have attempted to identify such predictors. HR variability, a surrogate of autonomic tone, has been examined with inconsistent results, as has been the experience with BP changes [9,11,15] and the development of symptoms [8,15]. This may reflect effects of aging and certain disease processes such as diabetes on the autonomic nervous system.…”

Section: Discussionmentioning

confidence: 99%

“…Although rare, ventricular arrhythmias have also been reported in patients with underlying heart disease who receive isoproterenol [7]. In an attempt to minimize these complications and reduce the costs associated with HUTT, investigators have attempted to establish early predictors of a positive HUTT [8]. Predictors that have been studied include various patient comorbidities [9], changes in heart rate (HR) [10] and blood pressure (BP) [11], HR variability [12,13,14] and symptom development [15] during HUTT.…”

Section: Introductionmentioning

confidence: 99%

Early Hemodynamic Changes during Head-Up Tilt Table Testing Can Predict a Neurocardiogenic Response in an African-American Patient Population

Ghods²,

Kumar³

et al. 2015

Cardiology

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Background: Head-up tilt table testing (HUTT) is time-consuming and associated with increased patient morbidity. Hemodynamic changes that occur during the early phase of HUTT may be predictive of neurocardiogenic syncope. Methods: A retrospective chart review was performed in 119 consecutive African Americans ( 57 ± 19) who underwent HUTT for evaluation of syncope of unknown etiology. Positive responses were defined as the development of symptoms linked with a systolic blood pressure (BP) <90 mm Hg, heart rate <50 b.p.m. or sinus arrest >3 s. Hemodynamic variables during the passive phase of HUTT were analyzed and results were then classified as a function of various predictors. Results: Sixty-two subjects (52%) had positive HUTT, and 57 (48%) had negative HUTT. Early changes in BP variables from baseline significantly predicted HUTT responses (p < 0.05). There was also a significant interaction between age and BP. An algorithm based on age and BP was developed which had positive and negative predictive values of 67.7 and 93%, respectively, with an accuracy of 79.8%. Conclusion: A novel algorithm utilizing the patients' age and changes in both systolic and diastolic BP during the early phase of HUTT enables the prediction of HUTT results without the use of vasoactive stimulation, allowing for rapid diagnosis, decreased patient morbidity and reduction in costs.

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“…Also, AP in patients with positive TTT has shown a trend toward significantly lower values at systolic phases, and larger systolic-diastolic differences [11]; and brain blood supply did not fluctuate during the TTT in patients with VS in some studies, though more recent ones showed changes when measured by Transcranial Doppler Ultrasounds. Some other potential risk factors for syncopal recurrence are the number and frequency of preceding syncope episodes, as well as nausea, dizziness, and diaphoresis (profusely sweating), as they were pointed out as predictive on the positive result of the TTT [25]. Finally, age, sex, bradychardia, and hypotension during the test were not found to influence the outcome prediction.…”

Section: Introductionmentioning

confidence: 97%

On the feasibility of tilt test outcome early prediction using ECG and pressure parameters

Gimeno-Blanes

Rojo-Álvarez

Caamaño

et al. 2011

EURASIP J. Adv. Signal Process.

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The tilt test is a valuable clinical tool for vasovagal syncope (VVS) diagnostic, and its early prediction from simple ECG and blood pressure-based parameters has widely been studied in the literature. However, no practical system is currently used in the clinical setting for the early prediction of the tilt test outcome. The objectives of this study were (1) to benchmark the early prediction performance of all the previously proposed parameters, when nonlinearly combined; (2) to try to improve this performance with the inclusion of additional information and processing techniques. We analyzed a database of 727 consecutive cases of tilt test. Previously proposed features were measured from heart rate and systolic/diastolic pressure tachograms, in several representative signal segments. We aimed to improve the prediction performance: first, using new nonlinear features (detrended fluctuation analysis and sample entropy); second, using a multivariable nonlinear classifier (support vector machine); and finally, including additional physiological signals (stroke volume). The predictive performance of the nonlinearly combined previously proposed features was limited [area under receiver operating characteristic curve (ROC) 0.57 ± 0.12], especially at the beginning of the test, which is the most clinically relevant period. The improvement with additional available physiological information was limited too. We conclude that the use of a system for tilt test outcome prediction with current knowledge and processing should be considered with caution, and that further effort has to be devoted to understand the mechanisms of VVS.

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Clinical findings as predictors of positivity of head-up tilt table test in neurocardiogenic syncope

Cited by 13 publications

References 21 publications

Ambulatory postural blood pressure changes and history allow a better selection of patients that should undergo a head-up tilt test

Ambulatory postural blood pressure changes and history allow a better selection of patients that should undergo a head-up tilt test

Early Hemodynamic Changes during Head-Up Tilt Table Testing Can Predict a Neurocardiogenic Response in an African-American Patient Population

On the feasibility of tilt test outcome early prediction using ECG and pressure parameters

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