The yield of head-up tilt testing is not significantly increased by repeating the baseline test

Abstract

Background and hypothesis: Head-up tilt is widely used in evaluating patients with syncope. Data suggest that baseline tilt without isoproterenol is associated with few (≤ 10%) positive results in normals. However, there is considerable day-to-day variability in patients with syncope, resulting in low reproducibility. We hypothesized that repeating the baseline tilt would increase the total number of positive responses. Methods: In all, 193 patients with syncope of unknown etiology prospectively underwent serial baseline tilt (Tilt-1 and Tilt-2) at 70° for 25 min on two consecutive days. Results: Of 193 patients, 39 (20%) had a positive Tilt-1. Of these, 19 had a positive Tilt-2, (positive concordance rate: 19/39 = 49%). Of 154 patients with a negative Tilt-1, 145 had a negative Tilt-2 (negative concordance rate: 142/151 =94%). Only 9 of 154 patients (6%) with a negative Tilt-1 had a positive Tilt-2. Thus, the yield increased from 20% (39/193) after Tilt-1, and to 25% (48/193) after Tilt-1 plus Tilt-2, p = NS. Conclusions: (1) Reproducibility of a positive Tilt-1 is moderate. (2) Reproducibility of a negative Tilt-1 is high. (3) Repetition of tilt in patients with a negative Tilt-1 does not significantly increase the number of positive results.