Head-up tilt test in patients with high pretest likelihood of neurally mediated syncope: An approximation to the 'real sensitivity' of this testing

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Abstract

This study was designed to examine the 'true sensitivity' of a specific head-up tilt (HUT) testing protocol using clinical findings. The HUT protocol used 45 minutes at 60°for the baseline portion and intermittent boluses of 2, 4, and 6 μg of isoproterenol in the second phase. Eighty-eight patients (40 men and 48 women; mean age of 33.8 ± 16 years) with recurrent syncope and high pretest likelihood of neurally mediated syncope were included. The following were considerated as high pretest likelihood criteria: (1) at least two syncopal episodes; (2) no structural heart disease and normal baseline ECG; (3) age < 65 years; (4) a typical history of neurally mediated syncope, triggering factors plus premonitory signs; and (5) short duration of symptoms and fast recovery without neurological sequelae. Fifty-four patients (61%) had a positive tilt test (34/88 baseline [39%] and 20/50 with isoproterenol [40%]). The shorter time interval between the last syncopal episode and baseline HUT test was the only predictor for a positive response (P < 0.003). Conversely, this time interval was not predictor of positive responses during isoproterenol-tilt testing. In conclusion: (1) we claim a 'sensitivity' for this combined protocol of 61%; and (2) our results indicate that patients with syncope of unknown origin must be tilted nearest as possible to the last syncope to increase the positive responses of HUT test.

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Pérez-Paredes, M., Picó-Aracil, F., Florenciano, R., Sánchez-Villanueva, J. G., Ros, J. A. R., & Ruipérez, J. A. (1999). Head-up tilt test in patients with high pretest likelihood of neurally mediated syncope: An approximation to the “real sensitivity” of this testing. PACE - Pacing and Clinical Electrophysiology, 22(8), 1173–1178. https://doi.org/10.1111/j.1540-8159.1999.tb00597.x

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