Key result
Carotid sinus massage and tilt testing diagnose ~61% of suspected reflex syncope with minimal overlap.
Why the study?
Following the standardization of indications, methodology, and diagnostic criteria for carotid sinus massage and tilt testing by the 2018 ESC guidelines, their effectiveness in a large real-world cohort needed assessment.
Do carotid sinus massage and tilt testing provide complementary diagnostic yield in patients >40 years old with suspected reflex syncope?
Cohort (n=3,293)
Do carotid sinus massage and tilt testing provide complementary diagnostic yield in patients >40 years old with suspected reflex syncope?
Carotid sinus massage and tilt testing offer complementary diagnostic value with minimal overlap, supporting the use of both tests in patients >40 years old with suspected reflex syncope.
Answers are grounded in this paper and cite their sources.
Suggests complementary diagnostic yield from combined testing in reflex syncope; leaves open effects on management and outcomes.
AIMS: Indications, methodology, and diagnostic criteria for carotid sinus massage (CSM) and tilt testing (TT) have been standardized by the 2018 Guidelines on Syncope of the European Society of Cardiology. Aim of this study was to assess their effectiveness in a large cohort which reflects the performance under 'real-world' conditions. METHODS AND RESULTS: We analysed all patients who had undergone CSM and TT in the years 2003-2019 for suspected reflex syncope. Carotid sinus massage was performed according to the 'Method of Symptoms'. Tilt testing was performed according to the 'Italian protocol' which consists of a passive phase followed by a sublingual nitroglycerine phase. For both tests, positive test was defined as reproduction of spontaneous symptoms in the presence of bradycardia and/or hypotension. Among 3293 patients (mean age 73 ± 12 years, 48% males), 2019 (61%) had at least one test positive. A bradycardic phenotype was found in 420 patients (13%); of these, 60% were identified by CSM, 37% by TT, and 3% had both test positive. A hypotensive phenotype was found in 1733 patients (53%); of these, 98% were identified by TT and 2% had both TT and CSM positive. CONCLUSION: The overall diagnostic yield of the tests in patients >40-year-old with suspected reflex syncope was 61%. Both CSM and TT are useful for identifying those patients with a bradycardic phenotype, whereas CSM has a limited value for identifying the hypotensive phenotype. Since the overlap of responses between tests is minimal, both CSM and TT should be performed in every patient over 40 years receiving investigation for unexplained but possible reflex syncope.
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Brignole et al. (2020) conducted a cohort in suspected reflex syncope (n=3,293). Carotid sinus massage and tilt testing was evaluated on Overall diagnostic yield (at least one test positive). Carotid sinus massage and tilt testing yielded an overall diagnostic rate of 61% in patients >40 years with suspected reflex syncope, with minimal overlap between the two tests.
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