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Head‐Up Tilt Test in Patients with High Pretest Likelihood of Neurally Mediated Syncope: An Approximation to the “Real Sensitivity” of this Testing
Author(s) -
PÉREZPAREDES MATÍAS,
PICÓARACIL FRANCISCO,
FLORENCIANO RAFAEL,
SÁNCHEZVILLANUEVA JOSÉ G.,
ANTONIO RUIZ ROS JOSÉ,
RUIPÉREZ JUAN A.
Publication year - 1999
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.1540-8159.1999.tb00597.x
Subject(s) - medicine , syncope (phonology) , cardiology , tilt table test , confidence interval , anesthesia , pediatrics , heart rate , blood pressure
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.