Abstract
Background Vasovagal syncope (VVS) is characterized by a wide spectrum of clinical presentations, but the relationship between clinical presentation and response to head-up tilt testing (HUT) has not yet been evaluated in detail. The aim of this study was to assess the relationship between the clinical presentation of VVS and HUT and clinical outcome at long-term follow-up. Methods Out of 671 consecutive subjects undergoing nitroglycerin-potentiated HUT for suspected VVS, 369 patients with normal electrocardiogram and no structural heart disease were included in our study. Results A history suggestive of typical or atypical VVS was obtained in 198 and 171 patients, respectively. The positivity rate of HUT was 65% and 36% in patients with established and likely VVS, respectively (P <0.0001). In patients with established VVS, a time interval of ≤28 days between the last syncope and HUT was the only independent predictor of a positive test. In patients with likely VVS, no variable was predictive of a positive HUT. At a mean follow-up of 43 ± 27 months, the rate of adverse events (all-cause mortality, syncope recurrence, and major diagnostic and/or therapeutic procedures) was similar in patients of both groups, independent of HUT results. Conclusion In patients with likely VVS, HUT has a low-diagnostic yield and may be inadequate to establish a reliable diagnosis. Similar long-term outcomes were observed in patients with positive or negative test results, suggesting that HUT is of limited value in the management of patients with suspected neurally mediated syncope.
| Original language | English |
|---|---|
| Pages (from-to) | 164-172 |
| Number of pages | 9 |
| Journal | PACE - Pacing and Clinical Electrophysiology |
| Volume | 37 |
| Issue number | 2 |
| DOIs | |
| Publication status | Published - Feb 2014 |
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Keywords
- clinical history
- head-up tilt testing
- vasovagal syncope
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
Cite this
Nitrate-potentiated head-up tilt testing (HUT) has a low diagnostic yield in patients with likely Vasovagal syncope. / Petix, Nunzia R.; Del Rosso, Attilio; Furlan, Raffaello; Guarnaccia, Vincenzo; Zipoli, Andrea.
In: PACE - Pacing and Clinical Electrophysiology, Vol. 37, No. 2, 02.2014, p. 164-172.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Nitrate-potentiated head-up tilt testing (HUT) has a low diagnostic yield in patients with likely Vasovagal syncope
AU - Petix, Nunzia R.
AU - Del Rosso, Attilio
AU - Furlan, Raffaello
AU - Guarnaccia, Vincenzo
AU - Zipoli, Andrea
PY - 2014/2
Y1 - 2014/2
N2 - Background Vasovagal syncope (VVS) is characterized by a wide spectrum of clinical presentations, but the relationship between clinical presentation and response to head-up tilt testing (HUT) has not yet been evaluated in detail. The aim of this study was to assess the relationship between the clinical presentation of VVS and HUT and clinical outcome at long-term follow-up. Methods Out of 671 consecutive subjects undergoing nitroglycerin-potentiated HUT for suspected VVS, 369 patients with normal electrocardiogram and no structural heart disease were included in our study. Results A history suggestive of typical or atypical VVS was obtained in 198 and 171 patients, respectively. The positivity rate of HUT was 65% and 36% in patients with established and likely VVS, respectively (P <0.0001). In patients with established VVS, a time interval of ≤28 days between the last syncope and HUT was the only independent predictor of a positive test. In patients with likely VVS, no variable was predictive of a positive HUT. At a mean follow-up of 43 ± 27 months, the rate of adverse events (all-cause mortality, syncope recurrence, and major diagnostic and/or therapeutic procedures) was similar in patients of both groups, independent of HUT results. Conclusion In patients with likely VVS, HUT has a low-diagnostic yield and may be inadequate to establish a reliable diagnosis. Similar long-term outcomes were observed in patients with positive or negative test results, suggesting that HUT is of limited value in the management of patients with suspected neurally mediated syncope.
AB - Background Vasovagal syncope (VVS) is characterized by a wide spectrum of clinical presentations, but the relationship between clinical presentation and response to head-up tilt testing (HUT) has not yet been evaluated in detail. The aim of this study was to assess the relationship between the clinical presentation of VVS and HUT and clinical outcome at long-term follow-up. Methods Out of 671 consecutive subjects undergoing nitroglycerin-potentiated HUT for suspected VVS, 369 patients with normal electrocardiogram and no structural heart disease were included in our study. Results A history suggestive of typical or atypical VVS was obtained in 198 and 171 patients, respectively. The positivity rate of HUT was 65% and 36% in patients with established and likely VVS, respectively (P <0.0001). In patients with established VVS, a time interval of ≤28 days between the last syncope and HUT was the only independent predictor of a positive test. In patients with likely VVS, no variable was predictive of a positive HUT. At a mean follow-up of 43 ± 27 months, the rate of adverse events (all-cause mortality, syncope recurrence, and major diagnostic and/or therapeutic procedures) was similar in patients of both groups, independent of HUT results. Conclusion In patients with likely VVS, HUT has a low-diagnostic yield and may be inadequate to establish a reliable diagnosis. Similar long-term outcomes were observed in patients with positive or negative test results, suggesting that HUT is of limited value in the management of patients with suspected neurally mediated syncope.
KW - clinical history
KW - head-up tilt testing
KW - vasovagal syncope
UR - http://www.scopus.com/inward/record.url?scp=84893785121&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84893785121&partnerID=8YFLogxK
U2 - 10.1111/pace.12235
DO - 10.1111/pace.12235
M3 - Article
C2 - 23992559
AN - SCOPUS:84893785121
VL - 37
SP - 164
EP - 172
JO - PACE - Pacing and Clinical Electrophysiology
JF - PACE - Pacing and Clinical Electrophysiology
SN - 0147-8389
IS - 2
ER -