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Comparison of Sensitivity and Specificity of Tilt Protocols with and without Isoproterenol in Children with Unexplained Syncope
Author(s) -
ALEHAN DURSUN,
LENK MUSTAFA,
ÖZME ŞENCAN,
ÇELIKER. ALPAY,
ÖZER SEMA
Publication year - 1997
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.1997.tb03565.x
Subject(s) - medicine , tilt (camera) , syncope (phonology) , heart rate , anesthesia , blood pressure , cardiology , tilt table test , vasovagal syncope , mechanical engineering , engineering
Head‐up tilt testing with or without isoproterenol is extensively used in the evaluation of patients with unexplained syncope. However, sensitivity and specificity of tilt protocols with and without isoproterenol have not been clarified in children, due to lack of age matched control subjects. This study was designed to assess and to compare the sensitivity and specificity of tilting alone and tilting in conjunction with isoproterenol. Thirty children with unexplained syncope (group I) and 15 age‐matched control subjects (control group I) underwent successive 60° head‐up tilts for 10 minutes during infusions of 0.02, 0.04, and 0.06 μg/kg/min of isoproterenol, after a baseline tilt to 60° for 25 minutes. Also, 35 children (group II) with unexplained syncope and 15 healthy control subjects (control group II) were evaluated by head‐up tilt to 60° for 45 minutes without an infusion of isoproterenol. In response to tilt protocol with graded isoproterenol, 23 (76.6%) of the patients in group I and 2 of the 25 (13.3%) control subjects developed syncope. Accordingly, the sensitivity of tilt testing with isoproterenol was 76.6%, and its specificity was 86.7%. Tilt testing without isoproterenol was positive in 17 (48.5%) of the patients in group II but in only 1 of the 15 (6.6%) control subjects. Thus, sensitivity and specificity of tilt testing without isoproterenol were 48.5% and 93.4%, respectively. The mean heart rate and systolic blood pressure decreased significantly (P < 0.001) in all tilt positive patients during syncope. In conclusion, the head‐up tilt test is a valuable diagnostic test in the evaluation of children with unexplained syncope, and isoproterenol is likely to increase the sensitivity of the test without decreasing its specificity.