Predictors of Response to the Head-Up Tilt Test in Patients with Unexplained Syncope or Presyncope

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Abstract

Background

Unexplained syncope is a relatively frequent symptom, mostly caused by a neurocardiogenic reaction. The purpose of this study was to determine predictors of response to head-up tilt testing (HUTT) in patients with unexplained syncope or presyncope.

Methods

HUTT was done in 640 consecutive patients with unexplained syncope or presyncope (393 men, mean age 45 ± 19 years) after initial workup including history, physical examination, and appropriate laboratory evaluation.

Results

Three hundred and forty-four (54%) patients had a positive result. The most common type of response was mixed type (46%) followed by vasodepressor (39%) and cardioinhibitory (15%) types. Age, gender, presence of structural heart disease, baseline heart rhythm, and the presenting symptom before the test failed to predict a positive response to HUTT, but among patients with a positive response to the test, age (OR: 1.54, CI = 1.04–2.47, P = 0.016) and presyncope (OR: 2.16, CI = 1.2–3.85, P = 0.008) as the presenting symptom predicted a vasodepressor type of response. The age (OR: 1.58, CI = 1.29–3.94, P = 0.01) and presyncope (OR: 4.6, CI = 1.74–12.24, P = 0.001) were also predictors for test positivity in the active stage.

Conclusions

There is an age-related gradient in hemodynamic response during neurocardiogenic syncope. The elderly patients more commonly had a vasodepressor and late response, in the active stage, but young subjects more commonly experienced an earlier and cardioinhibitory or mixed responses in the passive stage.

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