The normal response to prolonged passive head up tilt testing (original) (raw)
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Frontiers in Physiology, 2019
The paper presents a meta-analysis of studies comparing hemodynamic parameters: heart rate (HR), systolic blood pressure (sBP), diastolic blood pressure (dBP), and stroke volume (SV) measured during head-up tilt table test (HUTT) in patients with positive and negative HUT test outcome. Methods: Pubmed and Clinical Key databases were searched for English-only articles presenting results of biosignals measurements during tilt test in patients suffering from syncope. From 3,289 articles 13 articles published between 1997 and 2015 investigating 892 patients (467 with positive HUTT outcome and 401 with negative one) were selected. Results: There were not statistically significant differences observed between the parameters measured in supine position in patients with positive and negative test outcome [HR (p = 0.86), sBP (p = 0.32), dBP (p = 0.21), SV (p = 0.71)]. In tilt position the parameters HR and SV were significantly different when compared between the two groups of patients [HR (p = 0.02), sBP (p = 0.10), dBP (p = 0.59), SV (p = 0.0004)]. Conclusions: Changes in HR and SV parameters in response to tilt test turned out to be statistically significant. In supine position the differences between patients with positive and negative test outcome were not significant, hence tilt test can be considered as necessary in the diagnosis of vasovagal syndrome.
Reproducibility of head-up tilt test in patients with syncope
Clinical Cardiology, 1996
As the head-up tilt test (HUT) is employed to verify the efficacy of undertaking 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 ± 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 31 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.
Diagnostic utility of the head-up tilt test in syncope and the related complications
2017
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 ...
Responses to Tilt test in young and elderly patients with syncope of unknown origin
Biomedicine & Pharmacotherapy - BIOMED PHARMACOTHERAPY, 2004
The aim of the present study was to assess the cardiovascular autonomic function and responses to tilt test in young and elderly patients with syncope of unknown origin. We evaluated two groups of patients with previous unexplained syncope: 192 older subjects (112 males, 80 females, mean age 67.2 ± 6.8 years) and 188 young subjects (102 males, 86 females, mean age 25 ± 9 years). All patients underwent ambulatory electrocardiogram (ECG) monitoring, to evaluate time domain indices of heart rate variability (HRV), and head-up tilt test in the morning after an overnight fast. The responses of positive tilt test were classified using the VAsovagal Syncope International Study (VASIS) criteria: mixed (VASIS-1), cardioinhibition (VASIS-2A), severe cardioinhibition/asystole (VASIS-2B), pure vasodepression (VASIS-3). All the time-domain HRV indexes were lower in the older than in young subjects. The rate of positive responses was not different in the two groups. In elderly group the positive ...
Age and hemodynamic responses to tilt testing in those with syncope of unknown origin
Journal of the American College of Cardiology, 2003
OBJECTIVES We sought to determine whether there are age-related differences in vasovagal syncope. BACKGROUND In those with suspected vasovagal (neurocardiogenic) syncope, tilt testing demonstrates different hemodynamic responses. These responses may be age related, reflecting differing underlying pathophysiology. METHODS Using a two-stage tilt protocol with glyceryl trinitrate (GTN) provocation, 505 consecutive syncopal patients were studied. Their baseline characteristics and hemodynamic responses during both early and tilt-induced collapse were analyzed. Hemodynamic responses were classified using the VAsovagal Syncope International Study (VASIS) criteria: mixed, cardioinhibition, severe cardioinhibition/asystole, pure vasodepression, chronotropic incompetence, and excessive heart rate rise. Multivariate regression analyses were performed to determine the associations of the baseline clinical characteristics (including age) and the tilt-induced hemodynamic responses. RESULTS Thirty-three patients were unable to tolerate tilt testing. Age was independently associated with distinct responses during tilt. Chronotropic incompetence was predicted by increasing age (odds ratio [OR] 1.04, p Ͻ 0.0002). Younger age predicted an excessive heart rate rise (OR 0.97, p Ͻ 0.0005). Pure vasodepression was more common in the older group (Ͼ65 years; OR 29.5, p Ͻ 0.0001), whereas severe cardioinhibition was much less common in the older age group (OR 0.18, p Ͻ 0.0001). CONCLUSIONS There appear to be distinct pathophysiologies underlying vasovagal syncope in different age groups. Young people appear to have excessive cardiac and autonomic responses to stress, whereas older patients appear to have a more generalized cardiovascular decline, with attenuated cardiac and autonomic responses to stress.
[Analysis of head-up tilt test responses in patients suffering from syncope and high blood pressure]
Revista española de cardiología, 2006
We studied the difference in head-up tilt test responses between patients suffering from syncope who had hypertension and those who did not. A total of 338 consecutive patients with syncope underwent head-up tilt testing in our department from January 2003 to October 2004. Of these, 243 did not have hypertension (group A), whereas 95 did (group B). There were significant differences between the groups in age (P=.0001), sex (P=.048), timing of syncope development (P=.0001), and prevalence of diabetes mellitus (P=.0001). The head-up tilt test gave positive results in 168 patients (69.1%) in group A and in 63 (66.3%) in group B (P=.6; NS). There was no significant difference between the groups in the proportion of positive responses that occurred in either the baseline or nitroglycerin-enhanced phase of the test (P=.673; NS), nor in the time to onset of syncope in either phase (P=.69; NS, and P=.28; NS, respectively). However, there was a significant difference in the type of response ...
Sensitivity and Specificity of the Tilt Table Test in Young Patients with Unexplained Syncope
Pacing and Clinical Electrophysiology, 1993
The use/uJness of the head-up tilt testing (HUT) has heen previously addressed in diagnosing vasovagal neuroregulatory syncope in (he teenage population. However, data concerning sensitivity and specificity is deficient due to the lack of control groups. We compared the response to HUT in young patients re/erred because of syncope or near syncope fn -44, mean age 16 ± 3 years SD) to healthy young voJunteers with a normal physical examination and no previous history of syncope (n -18, mean age 16 ± 2 years) and io determine the sensitivity and specificity of HUT. The graded tilt protocol was performed at 15°, 30°, and 45° (each for 2 min), and then 60" for 20 minutes. Cuff blood pressure was measured every minute and lead II ECG was continuously monitored. Results; 25 of the 44 patients (57%) developed a vasovagaJ response or became symptomatic after 13.8 ± 5.7 minutes of HUT. Three of the 18 volunteers (17%) had a vasovagal response and became symptomatic after 9 ± 3 minutes of HUT. There was no statistical difference among the four groups (with and without tilt induced vasovagal response) in terms of age and baseline hemodynamic data. The sensitivity of 20 minutes HUT was 57% and its specificity was 83%. The presyncopal hemodynamic response in patients with history of syncope that was characterized by a significant decrease in systolic blood pressure and lack of increase of diastolic blood pressure as compared with baseline and with other groups. Gonclusions: 20 minutes at 60° HUT has a high specificity for the diagnosis of vasovagal syncope. Its limited sensitivity is counterbalanced by the advantage of limiting the incidence of false-positive results in patients without the vasovagal syndrome. (PACE, VoJ. 16, March, Part I 1993) tilt table test, syncope, teenagers, sensitivity, specificity Address for reprints: Fetnat M. Fouad, M.D., Department of Heart & Hypertension Research. 9500 Euclid Ave. (FFl-02b), Cleveland, OH 44195. Fax: (216) 444-9263.
Age and the Head-Up Tilt Test Outcome in Syncope Patients
Research in Cardiovascular Medicine, 2015
The head-up tilt test (HUTT) is a useful diagnostic tool for syncope. We sought to investigate the outcome of the HUTT in syncope patients and identify the relationship between age and different hemodynamic outcomes. In this cross-sectional study, we prospectively enrolled consecutive patients who presented with syncope and underwent the HUTT with a clinical suspicion of neurocardiogenic syncope after the exclusion of orthostatic hypotension cases. The HUTT consisted of consecutive passive and active phases. In the passive phase, the patients were tilted at 70 degrees for 20 minutes; and if negative, the test was repeated with 400 micrograms of sublingual nitroglycerin for another 20 minutes. Positive responses were classified according to the classification of the vasovagal syncope international study (VASIS) and compared for age and gender. A total of 498 patients were enrolled (age = 44.93 ± 18.77 years; male = 271 [54.4%]). Overall, 291 (58.4%) patients had a positive HUTT, while 256 (88.5%) patients had a positive result during the active phase. The test results were as follows: 107 (36.7%) mixed type (VASIS I), 103 (35.3%) cardioinhibitory (VASIS IIA = 44 [15.1%]; VASIS IIB = 59 [20.2%]), and 80 (27.4%) vasodepressive (VASIS III). There was no relationship between gender and syncope type. The trend of the HUTT result significantly changed with age, and the rate of cardioinhibitory syncope decreased after middle ages (P value for trend = 0.02). Hemodynamic response to the HUTT was associated with age. Cardioinhibitory response became less frequent with age due to exaggerated vagal activity in the younger patients as compared with the older subjects.
Early hemodynamic response to the tilt test in patients with syncope
Archives of medical science : AMS, 2014
Our aim was to evaluate the differences in the early hemodynamic response to the tilt test (HUTT) in patients with and without syncope using impedance cardiography (ICG). One hundred twenty-six patients (72 female/48 male; 37 ±17 years) were divided into a group with syncope (HUTT(+), n = 45 patients) and a group without syncope (HUTT(-), n = 81 patients). ECG and ICG signals were continuously recorded during the whole examination, allowing the calculation of heart rate (HR), stroke volume (SV), and cardiac output (CO) for every beat. The hemodynamic parameters (averaged over 1 min) were analyzed at the following points of the HUTT: the last minute of resting, the period immediately after the tilt (0 min), 1 min and 5 min after the maneuver. The absolute changes of HR, SV and CO were calculated for 0, 1, and 5 min after the maneuver in relation to the values at rest (ΔHR, ΔSV, ΔCO). Also, the percentage changes were calculated (HRi, SVi, COi). There were no differences between the g...
Elderly patients with unexplained syncope: What should be considered a positive tilt test response?
Autonomic Neuroscience, 2006
Introduction: Syncope is a common problem and can lead to serious consequences in the elderly. Tilt test is useful to investigate recurrent syncope, but few studies have investigated the hemodynamic responses of this population to tilt test. Objective: To describe the tilt test responses of elderly patients with recurrent syncope of unknown origin and to determine the occurrence of altered cardiovascular autonomic function in a subset of those with the diagnosis of dysautonomic pattern to the tilt test. Methods: Elderly patients (n = 165; > 60 years old) who sought medical assistance because of recurrent syncope during 18 months were initially enrolled and submitted to a two-stage, nitroglycerin-potentiated tilt test. A subset of patients who presented with dysautonomic response to tilt test performed clinical autonomic tests. Results: The most frequent cause of syncope during tilt test was the dysautonomic pattern (43%), followed by mixed type neurocardiogenic syncope (35%). Most patients who remained asymptomatic during tilt test showed clear abnormal hemodynamic response during the exam. Conclusion: Autonomic dysfunction, which can be found during tilt test, is probably an important cause of syncope in the elderly, regardless of the occurrence of symptoms during the tilt test.