Teste de inclinação (Tilt-test): do necessário ao imprescindível

Macedo, Paula; Leite, Luiz Roberto; Santos-Neto, Leopoldo Luiz dos; Hachul, Denise

doi:10.1590/s0066-782x2011005000006

Cited by 10 publications

(5 citation statements)

References 54 publications

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“…The literature shows great variability in positivity percentages10; this depends on the chosen method and the target population. Considering the Westminster protocol, the review article by Macedo et al estimates specificity rates with an average of 95% and sensitivity rates with a median of 31%, corroborating the general positivity rate present in this work 1,6 .…”

Section: Positivity Ratessupporting

confidence: 87%

“…International classifications for response types during the exam were followed, divided into vasodepressor, cardioinhibitory, mixed, psychogenic or tachycardiac orthostatic postural syndrome (POTS) responses. Patients over 60 years of age were considered elderly, according to the World Health Organization for developing countries [6][7][8][9] .…”

Section: Methodsmentioning

confidence: 99%

“…Elderly people have higher rates of dysautonomic responses than younger people, as well as more excellent patterns of hypotensive responses 14 , due to the higher incidence of pathologies that can lead to dysfunctions of the autonomic nervous system, such as diabetes mellitus, Parkinson's disease, renal failure, neurodegenerative diseases, in addition to the more significant number of drugs in use. Knowing the mechanisms of syncope is very important for risk-stratifying patients and helping to make therapeutic choices [6][7][8] , with evidence of improvement in care for these patients. In this context, elderly people without a described and established diagnosis presenting recurrent falls may suffer from high morbidity.…”

Section: Types Of Responsesmentioning

confidence: 99%

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What are the characteristics and results of Tilt Tests in the elderly?

Farias,

Ponte Filho,

Holanda

et al. 2024

J. Cardiac Arrhythmias

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Introduction: The elderly have several causes of syncope or pre-syncope. The importance of the Tilt Test (TT) has been questioned in this population. However, dysautonomic causes are common in these age groups, having an impact on morbidity and mortality. Objective: Compare the results of the TT between the age groups of the elderly (>=60 years) and the non-elderly. Methods: Crosssectional study carried out between 2016-2021. We used the Mann-Whitney and Chi-square tests, with a p-value < 5% considered significant. The protocols used were Westminster or Italian. Results: We analyzed 2364 tilt tests, 61.7% female, aged 51.1 (31-71) years. Positivity was 32.6%, 37.2% with sensitization (p < 0.0001). In the elderly group (EG), there were 958 tests (40.5%) and 1381 (58.4%) in the non-elderly (NEG). EG positivity was 270 (28.0%), lower than NEG with 524 (37.43%) (p < 0.01). Positivity with sensitization in EG was 195 (20.35%) x 403(29.18%) in NEG (p<0.001). In EG, 50 patients (5.22%) had a dysautonomic response and in NEG, there were 10 (0.72%) (p < 0.001). Complications were 4.2% EG x 2.6% NEG ( p= 0.03). Conclusion: The TT in the elderly showed a lower incidence of positivity in the passive and sensitization phases compared to the non-elderly. Vasovagal causes were the most frequent causes in the elderly, had a higher incidence of dysautonomic responses, fewer prodromes and a higher rate of complications, however without severity.

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Section: Positivity Ratessupporting

confidence: 87%

Section: Methodsmentioning

confidence: 99%

Section: Types Of Responsesmentioning

confidence: 99%

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What are the characteristics and results of Tilt Tests in the elderly?

Farias,

Ponte Filho,

Holanda

et al. 2024

J. Cardiac Arrhythmias

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“…Although no time was allotted to accommodation to the supine position at the start of the dental examination, it should not be considered as a major omission as arrhythmias during tilt-table tests usually last between 10 and 15 seconds [ 43 – 45 ].…”

Section: Discussionmentioning

confidence: 99%

Real-life dental examination elicits physiological responses different to visual and auditory dental-related stimuli

et al. 2021

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Background Previous studies on dental anxiety have examined the psychophysiological responses evoked in dentally anxious subjects by dental-related stimuli, but not during a real-life dental examination, which was achieved in the present study. Methods The heart rate, skin conductance level, and heart rate variability of 25 subjects with dental anxiety and 25 healthy controls were examined. Anxiety was determined by the Modified Dental Anxiety Scale and the Dental Anxiety Scale–Revised. The psychophysiological reactions of the two groups were compared during exposure to dental-related pictures, dental-related sounds, and an actual examination in a dental surgery. Results All the dental-related stimuli provoked an increase in heart rate, i.e. visual stimuli (p<0.001; 95% CI 0.98–3.95 bpm), auditory stimuli (p<0.001; 95% CI 1.34–4.99 bpm), and a dental examination (p<0.001; 95% CI 1.26–5.39 bpm). Dental-related pictures provoked inferior skin conductance level changes compared to dental-related sounds and the dental examination (visual modality vs auditory p<0.001; 95% CI 0.039–0.152; visual modality vs examination p<0.001; 95% CI 0.083–0.275). Heart rate variability manifested in a complex pattern of responses to the dental examination. However, when exposed to all three dental-related stimuli presentation conditions, the heart rate (F = 0.352, p = 0.556), skin conductance level (F = 0.009, p = 0.926), and heart rate variability parameters of subjects with dental anxiety did not differ in comparison to the healthy controls. Conclusions This pilot study represents an evaluation of psychophysiological reactions during a real-life dental examination compared to single modality stimuli, and shows that a real-life dental examination provokes an increase in heart rate, heart rate variability and skin conductance level. Additionally, autonomic responses did not differ between the experimental and control groups. The key issue for future studies is the effect of real-life situations on the physiological and psychological state of the subjects, which should be considered when planning new research and studied in depth.

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“…El tilt test (TT) es una herramienta no invasiva que contribuye al diagnóstico de diversos cuadros tales como síncope, cuadros presincopales, cuadros pseudosincopales o para diferenciar síncopes de cuadros convulsi-vos por epilepsia, en pacientes en los cuales se ha descartado la presencia de cardiopatías estructural, funcional o arritmias 1,2 . Pese a la moderada sensibilidad y especifi cidad, variable reproducibilidad y la positividad en un bajo porcentaje de casos control, se ha utilizado este método en la investigación del síncope desde su descripción en 1986 3 .…”

Section: Introductionunclassified

Descripción y análisis de las características de 442 pacientes con tilt test positivos

Santacruz¹

2019

RFEM

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Introducción. El tilt test (TT) constituye una técnica de utilidad para el diagnóstico de diversos cuadros tales como síncope, cuadros presincopales, cuadros pseudosincopales o para diferenciar síncopes de cuadros convulsivos por epilepsia. Este trabajo se llevó a cabo para establecer la frecuencia y características de los pacientes atendidos con un TT positivo en nuestra población. Pacientes y métodos: Sujetos ≥16 años, prueba de inclinación (TT) anormal atendidos en el Hospital Británico entre 2011 y 2016. Estudio retrospectivo descriptivo, con el objeto de describir el tipo de respuesta y características demográfi cas de los pacientes con TT alterado. Resultados. Se evaluaron 1052 TT, de los cuales 442 fueron positivos y se incluyeron en este estudio. El 63.1% fueron mujeres, la edad promedio de los pacientes fue de 50.9 ± 20.9 años. Se observó que el 40.5% correspondió a población sedentaria y 24.7% fueron hipertensos. El tipo de respuesta mayoritaria fue mixta en el 46.8%, seguida de vasopresora con 27.8%. Más de la mitad de los casos de hipotensión ortostática ocurrió en mujeres, con una relación de 1.7 mujeres por cada hombre y el 67% de las respuestas vasovagales ocurrió en mujeres, con una relación de 2:1. Discusión. Actualmente, el TT constituye un estudioutilizado para conocer el mecanismo implicado en la génesis del síncope o presíncope e instaurar la terapéutica adecuada. En el presente estudio la respuesta mixta (cardioinhibitoria + vasopresora) fue la más prevalente. Datos similares se observaron en estudios previos. Más aún, la mayoría de los pacientes correspondió a población femenina, lo cual se condice con lo evidenciado en la literatura.Palabras clave: disautonomía, síncope vasovagal, intolerancia ortostática, taquicardia postural ortostática, TT, prueba de inclinación o mesa basculante. .

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Teste de inclinação (Tilt-test): do necessário ao imprescindível

Cited by 10 publications

References 54 publications

What are the characteristics and results of Tilt Tests in the elderly?

What are the characteristics and results of Tilt Tests in the elderly?

Real-life dental examination elicits physiological responses different to visual and auditory dental-related stimuli

Descripción y análisis de las características de 442 pacientes con tilt test positivos

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