Reproducibility of head‐up tilt test in patients with syncope

Abstract

Summary: As the head-up tilt test (HUT) is employed to verify the efficacy of undertalung a treatment, we prospectively evaluated the reproducibility of positive and negative results, as well as that of the response type in 64 consecutive patients (mean age 34.6 & 22.9 years) with syncope of unknown cause. Two HUTS (60 min, 75"), separated by an interval of 9.77 k 8.21 days, were performed on each patient. Positive responses were reproduced in the second HUT in 54.5% of the patients. A greater reproducibility (84.3%) was observed for negative responses. Of the 3 1 patients with a negative first test, 5 had a positive response during the second HUT. Using a multivariate analysis, no clinical variable correlated with the reproducibility of positive or negative results. Likewise, neither arterial pressure nor heart rate observed during the test were correlated with reproducibility. Of 18 patients who reproduced positive responses, 12 (66.6%) did so with the same response modality. In three patients with documented monomorphic sustained ventricular tachycardia, which was hemodynamically well tolerated, and in one patient with temporal spike wave activity in the electroencephalogram, HUT was also positive. It was concluded that the low reproducibility of HUT limits its usefulness as a tool for evaluating treatment efficacy. The variability of the type of response suggests a common mechanism leading to cardioinhibitory and vasodepressor reactions. A positive result in only the second study shows the rationale of performing two tests when the first one is negative.

Comparison between tilt-table testing results performed during different periods of the day

“…Raviele et al 37 showed reproducibility to be 71% when the second examination is performed in an average of three 3 days after the first test. Blanc et al 38 , on the other hand, reported reproducibility to be 62% when the subsequent examination was undertaken after 7 days, but Ruiz et al 39 demonstrated that a positive TTT response could be reproduced in only 54.5% of the patients after a mean interval of 9.7 days (range 1 to 35 days). When the examinations were performed at average 7-day intervals, Hachul et al 40 observed the reproducibility of a positive response to be 82%, reduced to 77.8% when the same type of hemodynamic response was concerned.…”

Correlation of Postural Blood Pressure Test and Head-Up Tilt Table Test in Patients with Vasovagal Syncope

“…Secondly, the reproducibility of a positive TT varies broadly. Foglia-Manzillo et al [20 ]could reproduce a first positive TT in 77% of 34 patients, whereas Ruiz et al [21] found reproducibility rates for positive and negative TT results of 54.5 and 84.3%, respectively. For that reason, the TT is not a useful method to test therapeutic strategies for patients with vasovagal syncope.…”

Management and therapy of vasovagal syncope: A review

“…Second, the reproducibility of a positive head-up tilt table test varies enormously. Foglia-Manzillo et al [37] could reproduce a first positive head-up tilt table test in 77% of 34 patients, whereas Ruiz et al [38] found a reproducibility rate for the positive and negative head-up tilt …”