#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

The influence of the passive phase shortening on the diagnostic yield of nitroglycerine stimulated head-up tilt test


Authors: P. Mitro;  M. Szakács
Authors‘ workplace: III. interná klinika Lekárskej fakulty UPJŠ a FN L. Pasteura, Košice, Slovenská republika, prednosta doc. MUDr. Peter Mitro, Ph. D.
Published in: Vnitř Lék 2005; 51(11): 1272-1276
Category: Original Contributions

Overview

The aim of the study was to compare the diagnostic yield of three different head-up tilt test protocols. A total of 438 patients with syncope of unexplained etiology were examined. Protocol I was represented by Westminster protocol (passive test for 45 minutes, 60º) followed, if negative, by nitroglycerine (NTG) stimulated test for another 15 minutes. Protocol I was performed in 236 patients (99 men, 137 women, mean age 37.7 ± 18.9 years). In protocol II, passive phase was shortened to 30 minutes followed by 15 minutes NTG stimulated test. It was performed in 116 patients (38 men, 78 women, mean age 35.7 ± 18.9 years). Protocol III - Italian protocol - consisted of 20 minutes passive phase and 15 minutes NTG stimulated phase and was performed in 86 patients (25 men, 61 women, mean age 38.2 ± 18.1 years). The positivity rate of passive phase declines with the shortening of passive phase from 45 minutes to 30 minutes and 20 minutes respectively (21 % vs 9 % vs 18 %, p = 0,04) and it raises in NTG stimulated phase reciprocally (79 % vs 91 % vs 82 %, p = 0.04). The total positivity rate is not significantly different in three protocols (63 % vs 70 % vs 71 %, p = 0.81). Frequency of mixed type vasovagal syncope is decreasing (63 % vs 54 % vs 41 %, p = 0.004) and frequency of vasodepressor type is increasing (24 % vs 38 % vs 54 %, p = 0.003) by the shortening of passive phase of head-up tilt test. The frequency of cardioinhibitory type is the same. Duration of NTG stimulated phase is not different in three different protocols (6.8 ± 4.1 min vs 6.0 ± 4.1 min vs 5.4 ± 3.1 min, p = 0.16). Thus, the passive phase shortening of NTG stimulated head-up tilt test does not decrease the diagnostic yield of the test and has an advantage of time saving in this time consuming procedure.

Key words:
head-up tilt test - nitroglycerine - vasovagal syncope - diagnosis


Sources

1. Aerts AJ. Nitrate stimulated tilt table testing: a review of the literature. Pacing Clin Electrophysiol 2003; 26: 1528-1537.

2. Almquist A, Goldenberg IF, Milstein S et al. Provocation of bradycardia and hypotension by isoproterenol and upright posture in patients with unexplained syncope. N Engl J Med 1989; 320: 346-351.

3. Baron-Esquivias G, Pedrote A, Cayuela A et al. Long-term outcome of patients with asystole induced by head-up tilt test. Eur Heart J 2002; 23: 483-489.

4. Bartoletti A, Alboni P, Ammirati F et al. “The Italian Protocol”: a simplified head-up tilt testing potentiated with oral nitroglycerin to assess patients with unexplained syncope. Europace 2000; 2: 339-342.

5. Bartoletti A, Gaggioli G, Menozzi C et al. Head-up tilt testing potentiated with oral nitroglycerin: a randomized trial of the contribution of a drug-free phase and a nitroglycerin phase in the diagnosis of neurally mediated syncope. Europace 1999; 1: 183-186.

6. Brignole M, Menozzi C, Del Rosso A et al. 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. Vasovagal Syncope International Study. Europace 2000; 2: 66-76.

7. Brignole M, Alboni P, Benditt DG et al. Guidelines on management (diagnosis and treatment) of syncope-update 2004. Europace 2004; 6: 467-537.

8. Del Rosso A, Bartoletti A, Bartoli P et al. Methodology of head-up tilt testing potentiated with sublingual nitroglycerin in unexplained syncope. Am J Cardiol 2000; 85: 1007-1011.

9. Del Rosso A, Bartoli P, Bartoletti A et al. Shortened head-up tilt testing potentiated with sublingual nitroglycerin in patients with unexplained syncope. Am Heart J 1998; 135: 564-570.

10. Dvorak R, Kozak M, Semrad B et al. Neural syncope - a current therapeutic problem. Vnitr Lek 1995; 41: 846-850.

11. Fitzpatrick AP, Theodorakis G, Vardas P et al. Methodology of head-up tilt testing in patients with unexplained syncope. J Am Coll Cardiol 1991; 17: 125-130.

12. Foglia-Manzillo G, Giada F, Beretta S et al. Reproducibility of head-up tilt testing potentiated with sublingual nitroglycerin in patients with unexplained syncope. Am J Cardiol 1999; 84: 284-288.

13. Kenny RA, Ingram A, Bayliss J et al. Head-up tilt: a useful test for investigating unexplained syncope. Lancet 1986; 1: 1352-1355.

14. Lacunza Ruiz J, Garcia Alberola A, Sanchez Munoz JJ et al. Head-up tilt test potentiated with nitroglycerin. What is the optimal duration of the test after administration of the drug? Rev Esp Cardiol 20025; 55: 713-717.

15. Melenovsky V, Wichterle D, Malik J et al. Nitroglycerin induced syncope occurs in subjects with delayed phase shift of baroreflex action. Pacing Clin Electrophysiol 2002; 25: 828-832.

16. Mitro P, Trejbal D Present trends in the pathogenesis, diagnosis and therapy of vasovagal syncope. Vnitr Lek 1997; 43: 765-769.

17. Natale A, Sra J, Akhtar M et al. Use of sublingual nitroglycerin during head-up tilt-table testing in patients > 60 years of age. Am J Cardiol 1998; 82: 1210-1213.

18. Raviele A, Gasparini G, Di Pede F et al. Nitroglycerin infusion during upright tilt: a new test for the diagnosis of vasovagal syncope. Am Heart J 1994; 127: 103-111.

19. Raviele A, Menozzi C, Brignole M et al. Value of head-up tilt testing potentiated with sublingual nitroglycerin to assess the origin of unexplained syncope. Am J Cardiol 1995; 76: 267-272.

20. Zeng C, Liu G, Yang C et al. Evaluation of a single stage nitroglycerin tilt table test for diagnosis of neurally mediated syncope. Pacing Clin Electrophysiol 2001; 24: 1494-1499.

Labels
Diabetology Endocrinology Internal medicine

Article was published in

Internal Medicine

Issue 11

2005 Issue 11

Most read in this issue
Topics Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#