Key result
In patients with unexplained syncope, age and presyncope did not predict overall HUTT positivity, but predicted a vasodepressor response (age OR 1.54; presyncope OR 2.16) and active stage positivity.
Why the study?
What are the predictors of response to head-up tilt testing in patients with unexplained syncope or presyncope?
Observational (n=640)
What are the predictors of response to head-up tilt testing in patients with unexplained syncope or presyncope?
Older age and presyncope as the presenting symptom predict a vasodepressor and late response to head-up tilt testing in patients with unexplained syncope.
Should not yet change HUTT protocols; leaves open need for prospective validation of response predictors.
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.
No takes yet. Share an insight, caveat, or question.
Kazemi et al. (2006) conducted an observational in Unexplained syncope or presyncope (n=640). Head-up tilt testing (HUTT) was evaluated on Positive response to head-up tilt testing. In patients with unexplained syncope, age and presyncope did not predict overall HUTT positivity, but predicted a vasodepressor response (age OR 1.54; presyncope OR 2.16) and active stage positivity.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: