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The clinical presentation of syncope influences the head-up tilt test responses

Published:January 11, 2023DOI:https://doi.org/10.1016/j.ejim.2023.01.001

      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

      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)
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