Long‐Term Follow‐Up of Patients with Syncope Evaluated by Head‐Up Tilt Test

Background: Clinicians may be tempted to consider a positive head‐up tilt test (HUTT) an unfavorable prognostic indicator. We investigated whether results of routine HUTT predict long‐term recurrence of syncope. Methods: We analyzed syncope recurrence at long‐term among 107 patients (mean age 51 ± 20 years) receiving HUTT for diagnostic evaluation of unexplained/suspected neurocardiogenic syncope in our Institute. Results: HUTT was positive in 76 patients (vasodepressive response, n = 58; cardioinhibitory, n = 5; mixed, n = 13). During a median follow‐up of 113 months (range, 7–161), 34 (32%) patients experienced recurrence (24 [32%] with positive HUTT during 110 months (7–159); 10 [32%] with negative HUTT during 120 [22–161] months). Actuarial freedom from recurrence at 10 years did not significantly differ for patients with positive/negative test results (after passive/active phases) or with different positive response patterns (vasodepressive, cardioinhibitory, mixed). By contrast, history of >4 syncopes in the 12 months preceding HUTT stratified risk of recurrence, irrespective of HUTT positivity/negativity. At Cox proportional hazards analysis, history of >4 syncopes in the 12 months preceding HUTT was the single independent risk factor for recurrence both in the overall study population (HR, 1.7; 95% CI, 1.07–2.69) and within the subset of patients who tested positive (HR, 1.83; 95% CI, 1.07–3.17). Conclusions: This long‐term follow‐up study reinforces the concept that a positive HUTT should not be considered an unfavorable prognostic indicator; frequency of recent occurrences may be a more valid predictor. Ann Noninvasive Electrocardiol 2010;15(2):101–106