Usefulness of head-up tilt test in evaluating patients with syncope of unknown origin and negative electrophysiologic study

Raviele, Antonio; Gasparini, G.; Pede, Francesco Di; Delise, Pietro; Bonso, Aldo; Piccolo, E

doi:10.1016/0002-9149(90)91321-v

Cited by 250 publications

(57 citation statements)

References 25 publications

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“…Studies of the passive tilt test show a positive response rate of 26% to 75%. 7,[13][14][15] The rate of positive response for the passive tilt test was 1.3% (1 / 78) in the present study. The discrepancy between the positive response rates of the present study and above mentioned studies may be related to the different protocols used.…”

Section: Discussionsupporting

confidence: 45%

“…Some studies reporting the time to the development of a positive response found the average time was 30 minutes for a 60-degree tilt and 10 minutes for an 80-degree tilt. [7][8][9]13,14,16,19) Our data showed that the average time to the development of a positive response was 4.3 ± 2.9 min for an 80-degree tilt in 73 patients. The pathophysiologic mechanism of N-M syncope is not fully understood.…”

Section: Discussionmentioning

confidence: 57%

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<b>Usefulness of Head-up Tilt Test in the Evaluation and Management of Unexplained Syncope or Pre-syncope</b>

Fang

Kuo

2000

Jpn Heart J

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SUMMARYThis study included 87 consecutive patients with unexplained syncope or pre-syncope who had undergone the head-up tilt (HUT) test with concomitant isoproterenol infusion. A positive response was defined as development of syncope or pre-syncope in association with substantial hypotension (decline of systolic blood pressure > 20 mmHg). Coronary artery spasm was suggested from the clinical symptoms and electrocardiographic findings in 1 patient (1 / 87 = 1.1%). Intolerance to isoproterenol infusion was noted in 8 cases (8 / 87 = 9%). Of the 78 patients who completed the study, 73 showed positive responses (73 / 78 = 94%). (baseline systolic blood pressure = 125 ± 23 mmHg vs endpoint systolic blood pressure = 76 ± 11 mmHg, p < 0.05; baseline heart rate = 73 ± 14 beats per minute vs endpoint HR = 80 ± 24 beats per minute, p < 0.05). In 73 patients who showed positive responses, the systolic blood pressure (SBP) and heart rate (HR) returned to a safe level at 2 minutes when the patients were returned to a supine position (post-study 2 minutes SBP = 124 ± 18 mmHg vs baseline SBP = 125 ± 23 mmHg, p = NS; post-study 2 minutes HR = 82 ± 18 beats per minute vs baseline HR = 73 ± 14 beats per minute, p < 0.05). All 73 patients with a positive HUT test received Atenolol therapy (50 mg daily). Only 35 of these 73 patients took Atenolol regularly and had a repeat HUT test. After atenolol therapy, persistent positive responses were observed in 19 cases (19 / 35 = 54%) and negative responses were noted in 16 cases (16 / 35 = 46%). The mean dosage of isoproterenol needed to provoke a positive HUT test in 19 patients who had received Atenolol therapy and had a positive repeat HUT test was 2.3 ± 1.2 µg / min at baseline and 3.5 ± 0.9 µg / min for post-Atenolol therapy (p < 0.001). Sixteen patients with a negative repeat HUT test were treated continuously with Atenolol and followed for a mean period of 13 ± 11 months (range, 1-34 months). All 16 patients were free of syncope or pre-syncope during the period of follow up. In conclusion, the HUT test is mostly well tolerated and safe, even though the test has a low rate of adverse effects. Atenolol is effective for the prevention of provoked or spontaneous recurrent syncope or pre-syncope. (Jpn Heart J 2000; 41: 623-631)

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Section: Discussionsupporting

confidence: 45%

Section: Discussionmentioning

confidence: 57%

<b>Usefulness of Head-up Tilt Test in the Evaluation and Management of Unexplained Syncope or Pre-syncope</b>

Fang

Kuo

2000

Jpn Heart J

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“…[1][2][3][4][5][6][7][8][9][10] The pathophysiology of vasovagal syncope is not fully understood and the most widely accepted pathophysiologic mechanism is that the decrease in venous return on the assumption of upright posture during HUT testing stimulates baroreceptors and leads to increased sympathetic activity. In this situation, there is increased inotropism in the relatively empty left ventricle, 14 which leads to a hyperstimulation of C receptors in the left ventricular wall.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 In the absence of demonstrable cardiovascular or neurological abnormalities, vasovagal syncope is believed to be the most frequent etiology. 1,[7][8] Vasovagal syncope is characterized by a sudden reduction in sympathetic vasoconstrictor outflow together with an increase in parasympathetic activity, resulting in vasodilatation and/or bradycardia. Although it has been disputed, vasovagal syncope may be triggered by an excessive afferent discharge from arterial or visceral, particularly ventricular, mechanoreceptors.…”

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confidence: 99%

Long-Term Effects of Pharmacological Therapy for Vasovagal Syncope on the Basis of Reproducibility During Head-Up Tilt Testing

et al. 1998

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“…The table angle, duration of tilting and addition of pharmacologic stimulation are all under the examiner's control. [5] Reduced baroreceptor sensitivity during head-up tilt test is valuable in predicting the recurrence of syncope, thus supporting its potential usefulness in the clinical management of patients. [6] The most common indication for tilt table testing is to confirm a diagnosis of reflex syncope in patients in whom this diagnosis has been suspected but not confirmed by the initial evaluation.…”

Section: Introductionmentioning

confidence: 98%

Diagnostic utility of the head-up tilt test in syncope and the related complications

Salwan¹,

Salwan²,

Wadhwa³

2017

Int. J. Adv. Res. Biol. Sci

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Background: Recurrent syncope is a distressing symptom in which the cause may remain undetermined. A definitive diagnosis may help the patients to lead a normal life and avoid the unnecessary risk to their lives. Objective: To evaluate the effectiveness and safety of Head up Tilt Test (HUTT) in patients with undiagnosed syncope and to detect and follow up any complications arising out of the procedure. Material and methods: The head up tilt table test was performed in department of cardiology. 72 patients with a history of syncope or presyncope underwent upright tilt table testing to exclude vasovagal syncope, with baseline tilt and if negative followed by progressively increasing doses of isoprenaline infusion. 70° tilt was used and continuous heart rate and non-invasive BP recordings were made every 2 minutes or earlier when symptomatic. Results: The mean age of the patients was 48±16 years. None of the patients had carotid sinus hypersensitivity. Forty-five patients (62.5%) were positive for syncope. Four (5.55 %) were positive during the baseline tilt and forty-one (56.9%) were positive with the use of isoprenaline during tilt. The majority of positive responses were mixed 23 (51.11%), 17(37.77%) were vasodepressor and 5(11.11%) were cardioinhibitory. The mean time to syncope was 31.84 ± 8.0 minutes. There was a mean drop of 55.65 mmHg in systolic blood pressure and 36.06 mmHg in diastolic blood pressure in the positive group (p = <0.001 for both).No statistical significance was observed as regards the age ,sex and type of response. No significant untoward incidents were noted except partial seizures in one patient. Conclusion:The head-up tilt test is a simple, non-invasive, relatively safe test which is useful in documenting objective measures of orthostatic hypotension that cannot be obtained in a clinical setting.

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Usefulness of head-up tilt test in evaluating patients with syncope of unknown origin and negative electrophysiologic study

Cited by 250 publications

References 25 publications

<b>Usefulness of Head-up Tilt Test in the Evaluation and Management of Unexplained Syncope or Pre-syncope</b>

<b>Usefulness of Head-up Tilt Test in the Evaluation and Management of Unexplained Syncope or Pre-syncope</b>

Long-Term Effects of Pharmacological Therapy for Vasovagal Syncope on the Basis of Reproducibility During Head-Up Tilt Testing

Diagnostic utility of the head-up tilt test in syncope and the related complications

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