Key result
Front-loaded glyceryl trinitrate-provoked head-up tilt testing increased the diagnostic rate of unexplained syncope by 24.8% (95% CI 16.3-33.4%) compared to standard passive tilt testing.
Why the study?
Does a shortened 'front-loaded' 20-min glyceryl trinitrate-provoked head-up tilt test improve diagnostic yield compared to standard 40-min passive tilt in patients with unexplained syncope?
Population
149 consecutive patients with unexplained syncope and 83 asymptomatic controls (total n=232)
Comparison
Shortened 'front-loaded' 20-min glyceryl… vs Standard 40-min passive head-up tilt (HUT)
Design
RCT, Randomly assigned to FLGTN-HUT or HUT, then the opposite tilt-test 1 week…
Follow-up
1 week
Authors
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Supports shorter front-loaded GTN tilt testing to raise diagnostic yield in unexplained syncope; extends RCT evidence for provocative protocols.
RCT (n=232)
randomly assigned
Does a shortened 'front-loaded' 20-min glyceryl trinitrate-provoked head-up tilt test improve diagnostic yield compared to standard 40-min passive tilt in patients with unexplained syncope?
Effect estimate: 24.8% absolute difference (95% CI 16.3-33.4)
Absolute Event Rate: 36.2% vs 11.4%
A front-loaded 20-minute glyceryl trinitrate-provoked head-up tilt test provides a higher diagnostic rate and is faster than standard 40-minute passive tilt testing, though with higher false positivity.
Parry et al. (2008) conducted an RCT in unexplained syncope (n=232). front-loaded 20-min glyceryl trinitrate-provoked head-up tilt (FLGTN-HUT) vs. standard 40-min passive tilt (HUT) was evaluated on diagnostic haemodynamic changes and symptom reproduction (24.8% absolute difference, 95% CI 16.3-33.4). Front-loaded glyceryl trinitrate-provoked head-up tilt testing increased the diagnostic rate of unexplained syncope by 24.8% (95% CI 16.3-33.4%) compared to standard passive tilt testing.
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