- •The nitroglycerin (NTG) head up tilt test (HUTT) sensitivity was 81.5% in patients with classical vasovagal syncope (VVS).
- •The HUTT positivity rate was about 1.5 times higher in patients with classical VVS compared to those with non-classical VVS.
- •Among patients with classical VVS, there was a higher relative prevalence of mixed and vasodepressor forms.
- •The relative prevalence of cardioinhibitory forms was higher in patients with non-classical VVS.
Materials and Methods
Abbreviations:TLOC (transient loss of consciousness), ECG (electrocardiogram), BP (Blood Pressure), NTG (nitroglicerin), HUTT (head-up tilt test), ACE-Is (angiotensin 1 converting enzyme inhibitors), ARBs (angiotensin II receptor blockers)
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- Tilt testing remains a valuable asset.Eur Heart J. 2021; 42: 1654-1660
- Head-up tilt testing for diagnosing vasovagal syncope: a meta-analysis.Int J Cardiol. 2013; 168: 27-35
- Therapy of vasovagal syncope: to prevent the vasovagal reflex or to treat the impending reflex?.EP Europace. 2010; 12 (June): 776-778
- The different clinical presentations of vasovagal syncope.Heart. 2015; 101 (MayEpub 2015 Mar 19): 674-678
- The Italian Protocol': a simplified head-up tilt testing potentiated with oral nitroglycerin to assess patients with unexplained syncope.Europace. 2000; 2 (Oct): 339-342
- New classification of haemodynamics of vasovagal syncope: beyond the VASIS classification. Analysis of the pre-syncopal phase of the tilt test without and with nitroglycerin challenge.Europace. 2000; 2: 66-76
- Document Group et al. Practical instructions for the 2018 ESC Guidelines for the diagnosis and management of syncope.Eur Heart J. 2018; 39: e43-e80
- Physical injuries caused by a transient loss of consciousness: main clinical characteristics of patients and diagnostic contribution of carotid sinus massage.Eur Heart J. 2008; 29 (MarEpub 2007 Dec 16): 618-624
- Effect of clinical triggers on positive responses to tilt-table testing potentiated with nitroglycerin or clomipramine.Am J Cardiol. 2011; 107: 1693-1697
- Value of head-up tilt testing potentiated with sublingual nitroglycerin to assess the origin of unexplained syncope.Am J Cardiol. 1995; 76: 267-272
- Nitrate-potentiated head-up tilt testing (HUT) has a low diagnostic yield in patients with likely vasovagal syncope.Pacing Clin Electrophysiol. 2014; 37 (Feb): 164-172
- International Study on Syncope of Uncertain Etiology 3 (ISSUE-3) Investigators. Diagnosis of neurally mediated syncope at initial evaluation and with tilt table testing compared with that revealed by prolonged ECG monitoring. An analysis from the Third International Study on Syncope of Uncertain Etiology (ISSUE-3).Heart. 2013; 99: 1825-1831
- Association between hypotension during 24 h ambulatory blood pressure monitoring and reflex syncope: the SynABPM 1 study.Eur Heart J. 2022; (Jun 29): ehac347
- Management strategies for recurrent vasovagal syncope.Intern Med J. 2010; 40 (Aug): 554-560
- Prevalence of asystole during tilt test-induced vasovagal syncope may depend on test methodology.EP Europace. 2022; : euac154
- The pathophysiology of vasovagal syncope: Novel insights.Auton Neurosci. 2021; 236 (Dec)102899
- BioSync CLS trial Investigators. Cardiac pacing in severe recurrent reflex syncope and tilt-induced asystole.Eur Heart J. 2021; 42 (Feb 1): 508-516
- Impact of dual-chamber pacing with closed loop stimulation on quality of life in patients with recurrent refex vasovagal syncope: results of the SPAIN study.Europace. 2020; 22: 314-319
- Does cardiac pacing reduce syncopal recurrences in cardioinhibitory vasovagal syncope patients selected with head-up tilt test? Analysis of a 5-year follow-up database.Int J Cardiol. 2018; 270: 149-153
- The effect of dual-chamber closed-loop stimulation on syncope recurrence in healthy patients with tilt-induced vasovagal cardioinhibitory syncope: a prospective, randomised, single-blind, crossover study.Heart. 2013; 99 (Nov): 1609-1613
- 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy.Europace. 2022; 24 (Jan 4): 71-164
- The main determinant of hypotension in nitroglycerine tilt-induced vasovagal syncope.Pacing Clin Electrophysiol. 2012; 35 (Jun): 739-748
- Which hemodynamic parameter predicts nitroglycerin-potentiated head-up tilt test response?.Pacing Clin Electrophysiol. 2015; 38 (Apr): 507-513
- The effects of gender and test protocol on the results of head-up tilt test in patients with vasovagal syncope.Kardiol Pol. 2009; 67 (Aug): 1029-1034
- Clinical predictors of head-up tilt test outcome during the nitroglycerin phase.Clin Auton Res. 2010; 20 (Jun): 167-173
- Age-related tilt test responses in patients with suspected reflex syncope.Europace. 2021; 23 (Jul 18): 1100-1105
- A higher proportion of men than of women fainted in the phase without nitroglycerin in tilt-induced vasovagal syncope.Clin Auton Res. 2020; 30 (Oct): 441-447
- Underlying hemodynamic differences are associated with responses to tilt testing.Sci Rep. 2021; 11 (Sep 9): 17894
- Physical injuries caused by a transient loss of consciousness: main clinical characteristics of patients and diagnostic contribution of carotid sinus massage.Eur Heart J. 2008; 29 (Mar): 618-624
- Risk of Electrolyte Disorders, Syncope, and Falls in Patients Taking Thiazide Diuretics: Results of a Cross-Sectional Study.Am J Med. 2021; 134 (Sep): 1148-1154
- Low-blood pressure phenotype underpins the tendency to reflex syncope.J Hypertens. 2021; 39 (Jul 1): 1319-1325
- Impairment of Endothelial Function by Cigarette Smoke Is Not Caused by a Specific Smoke Constituent, but by Vagal Input From the Airway.Arterioscler Thromb Vasc Biol. 2022; 42 (Nov): 1324-1332
- Endothelial function and peripheral vasomotion in the brachial artery in neurally mediated syncope.Clin Cardiol. 2000; 23: 820-824
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The authors did not report conflicts of interest.
The data that support the findings of this study are available from the corresponding author, upon reasonable request.