Highlights
- •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.
ABSTRACT
Introduction
Little is still known about the positivity rate of nitroglycerin (NTG) potentiated
head-up tilt test (HUTT) according to the history-based clinical features of syncope.
The study aimed to compare the HUTT positivity rate and type of responses in patients
with classical and non-classical vasovagal syncope (VVS).
Materials and Methods
We retrospectively evaluated all consecutive patients who underwent NTG-potentiated
HUTT for VVS. The study population was dichotomized into classical and non-classical
VVS.
Results
A total of 1285 VVS patients (45± 19.1 years; 49.6% male) were enrolled: 627 (48.8%)
had a history of classical VVS and 658 (51.2%) of non-classical VVS. HUTT was positive
in 866 (67.4%) patients. The positivity rate was significantly higher in patients
with classical compared to those with non-classical VVS (81.5% vs 54%; P< 0.0001). Cardioinhibitory response showed similar total positivity rate (27.6% vs 31%; P= 0.17), but higher relative prevalence among positive tests (57.7% vs 33.9%, P< 0.0001) in patients with non-classical VVS. At multivariable analysis, classical
reflex syncope, male sex, history of traumatic syncope and use of diuretics were independent
predictors of HUTT positivity.
Conclusion
The clinical presentation of syncope influences the overall HUTT positivity rate and
the type of responses. Cardioinhibitory response and traumatic syncope are more likely
in patients with non-classical VVS.
Graphical abstract
Graphical Abstract
Keywords
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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 11, 2023
Accepted:
January 2,
2023
Received in revised form:
December 8,
2022
Received:
October 8,
2022
Publication stage
In Press Corrected ProofFootnotes
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.
Identification
Copyright
© 2023 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
