Key result
While POTS criteria were met within 7 minutes, a 40-minute tilt test identified a 36% prevalence of overlapping vasovagal syncope in POTS cases compared to 7% in controls (P=0.02).
Why the study?
Does a 40-minute tilt test improve the identification of overlapping vasovagal syncope compared to shorter durations in patients with suspected postural tachycardia syndrome?
Case-Control (n=56)
Does a 40-minute tilt test improve the identification of overlapping vasovagal syncope compared to shorter durations in patients with suspected postural tachycardia syndrome?
Absolute Event Rate: 36% vs 7%
p-value: p=0.02
While a 10-minute tilt test is sufficient to diagnose POTS in most patients, a 40-minute duration is optimal to identify the significant overlap with vasovagal syncope.
Extended tilt testing may identify vasovagal overlap in POTS; leaves open whether protocols should change.
AIMS: The aim of this study is to define the optimal duration of tilt testing for the assessment of patients with suspected postural tachycardia syndrome (POTS). METHODS AND RESULTS: This was a case-control study. Cases were identified retrospectively from a database of patients referred with orthostatic intolerance (OI). All met the diagnostic criteria for POTS. Controls were enrolled prospectively. All subjects underwent tilting to 70 degrees for 40 min if tolerated. Continuous monitoring was provided by a Finometer. Analysis of responses to tilting was performed on 28 cases and 28 controls. The mean age in the case group was 23.6 and in the control group was 26.2. The majority was female in both groups (cases = 4F:3M, controls = 2F:1M). All cases met the criteria for POTS within 7 min of orthostasis. No controls demonstrated a sustained tachycardia. The prevalence of vasovagal syncope (VVS) was 36% in cases vs. 7% in controls (P = 0.02) and 25% in the remaining patients (n = 233) on the OI database (P = 0.259). CONCLUSION: A 10 min tilt will diagnose POTS in the majority of patients. It will not, however, be sufficient to identify the overlap that exists between POTS and VVS. The optimal duration of tilt testing in patients suspected of POTS is 40 min.
No takes yet. Share an insight, caveat, or question.
Carew et al. (2009) conducted a case-control in Suspected postural tachycardia syndrome (POTS) (n=56). Postural tachycardia syndrome (POTS) vs. Controls without POTS was evaluated on Prevalence of vasovagal syncope (VVS) during 40-minute tilt testing (p=0.02). While POTS criteria were met within 7 minutes, a 40-minute tilt test identified a 36% prevalence of overlapping vasovagal syncope in POTS cases compared to 7% in controls (P=0.02).