Key result
Shortened HUTT yields similar positivity rates to standard protocols for suspected vasovagal syncope.
Why the study?
Head-up tilt testing diagnoses vasovagal syncope, but its duration limits widespread adoption.
Does a shortened head-up tilt test protocol provide adequate diagnostic yield in patients with suspected vasovagal syncope?
Observational (n=614)
Does a shortened head-up tilt test protocol provide adequate diagnostic yield in patients with suspected vasovagal syncope?
Absolute Event Rate: 58.63% vs 60.91%
p-value: p=0.449
A shortened head-up tilt test protocol maintains a high diagnostic yield of 60.91% while reducing total test time by at least 37.5% compared to consensus recommendations.
Shortened HUTT may aid VVS diagnosis in practice; leaves open prospective validation against standard protocols.
OBJECTIVE: The head-up tilt test (HUTT) diagnoses Vasovagal Syncope (VVS) but its duration limits adoption. We evaluated a shortened HUTT protocol in patients from Central China. METHODS AND RESULTS: We retrospectively analyzed 614 patients (median age 53.5 years, 53.2% female) with suspected VVS. All underwent a standardized HUTT with a 10 min passive phase at 70°, followed, if negative, by a 15 min active phase with 0.5 mg sublingual nitroglycerin. The overall positivity rate was 60.91% (374/614), with the vast majority (359/374) of positive responses occurring during the active phase. The median positive response time was 10 min (IQR: 6.5-10) for the passive phase and 3 min (IQR: 2-5min) for the active phase, with peak incidences observed at these intervals. The positivity rates for the 10 min and 15 min active phases were 58.63% and 60.91%, respectively, with no statistically significant difference (p = 0.449). Through generalized additive model (GAM) analysis with inflection point detection, a significant nonlinear relationship between time and positivity was identified (EDF = 2.302, p < 0.001). Independent predictors of a positive test included female gender, increasing age, prior syncope before HUTT, and lower systolic blood pressure at 10 min of the passive phase. CONCLUSION: Our shortened HUTT protocol achieved comparable diagnostic yield in these patients while reducing test duration. Compared with the consensus-recommended protocol, the shortened HUTT protocol saved at least 37.5% of the total test time, while achieving a positive rate (60.91%).
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Wu et al. (2026) conducted an observational in Suspected Vasovagal Syncope (n=614). 10-minute active phase head-up tilt test vs. 15-minute active phase head-up tilt test was evaluated on Positivity rate (p=0.449). A shortened head-up tilt test with a 10-minute active phase yielded a similar positivity rate to a 15-minute active phase (58.63% vs 60.91%, p=0.449) in patients with suspected vasovagal syncope.
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