Nitroglycerin-potentiated head-up tilt test induced cardioinhibitory syncope with asystole in 28.6% of patients, with diuretic use being the strongest independent predictor (OR 9.94).
Observational (n=1,285)
No
What are the clinical predictors of cardioinhibitory syncope with asystole during nitroglycerin-potentiated head-up tilt testing in patients with suspected reflex syncope?
Male sex, smoking, traumatic syncope, and diuretic use are independent predictors of cardioinhibitory syncope with asystole during nitroglycerin-potentiated head-up tilt testing.
Effect estimate: OR 9.94 (95% CI 3.83-25.76)
Absolute Event Rate: 7.6% vs 1.2%
p-value: p=<0.001
AIMS: The aim of our study was to evaluate the prevalence and clinical predictors of cardioinhibitory (CI) responses with asystole at the nitroglycerin (NTG)-potentiated head-up tilt test (HUTT) in patients with a history of syncope admitted to a tertiary referral syncope unit. METHODS: We retrospectively evaluated all consecutive patients who underwent NTG-potentiated HUTT for suspected reflex syncope at our institution from March 1 2017 to May 1 2020. The prevalence of HUTT-induced CI syncope was assessed. Univariate and multivariate analyses were performed to test the association of asystolic response to HUTT with a set of clinical covariates. RESULTS: We enrolled 1285 patients (45 ± 19.1 years; 49.6% male); 368 (28.6%) showed HUTT-induced CI response with asystole. A multivariate analysis revealed that the following factors were independently associated with HUTT-induced CI syncope: male sex (OR 1.48; ConInt 1.14-1.92; P = 0.003), smoking (OR 2.22; ConInt 1.56-3.115; P < 0.001), traumatic syncope (OR: 2.81; ConInt 1.79-4.42; P < 0.001), situational syncope (OR 0.45; ConInt 0.27-0.73; P = 0.002), and the use of diuretics (OR 9.94; ConInt 3.83-25.76; P < 0.001). CONCLUSIONS: The cardioinhibitory syncope with asystole induced by NTG-potentiated HUTT is more frequent than previously reported. The male gender, smoking habit, history of traumatic syncope, and use of diuretics were independent predictors of HUTT-induced CI responses. Conversely, the history of situational syncope seems to reduce this probability.
Russo et al. (Fri,) conducted a observational in Suspected reflex syncope (n=1,285). Nitroglycerin-potentiated head-up tilt test was evaluated on Use of diuretics as a predictor of HUTT-induced cardioinhibitory syncope (OR 9.94, 95% CI 3.83-25.76, p=<0.001). Nitroglycerin-potentiated head-up tilt test induced cardioinhibitory syncope with asystole in 28.6% of patients, with diuretic use being the strongest independent predictor (OR 9.94).