Key result
Patients with syncope had a significantly higher rate of positive responses to the direct drug-potentiated head-up tilt test compared to patients with precursor syncope (65.9% vs 44.8%, OR 6.223).
Why the study?
The head-up tilt test is useful for suspected vasovagal syncope, but further evaluation of the direct drug-potentiated test in recurrent or precursor syncope was needed.
Does the direct drug-potentiated HUTT effectively diagnose vasovagal syncope in patients presenting with syncope or precursor syncope?
Observational (n=4,873)
No
Does the direct drug-potentiated HUTT effectively diagnose vasovagal syncope in patients presenting with syncope or precursor syncope?
Odds Ratio: 6.223 (95% CI 5.116–7.595)
Absolute Event Rate: 65.9% vs 44.8%
p-value: p=<0.001
The direct drug-potentiated HUTT is a safe and sensitive diagnostic tool for vasovagal syncope, and may be particularly useful in young females presenting with precursor symptoms like weakness and sweating to prevent missed diagnoses.
May aid VVS diagnosis via drug-potentiated HUTT; hypothesis-generating and requires prospective validation before practice change.
Background: The head-up tilt test (HUTT) is a useful diagnostic tool in patients with suspected vasovagal syncope (VVS). Objectives: We aimed to investigate the direct drug-potentiated HUTT in patients with recurrent syncope or precursor syncope and to assess the diagnostic value of the direct drug-potentiated HUTT. Methods: The medical history and direct drug-potentiated HUTT records of patients who complained of syncope or precursor syncope and who visited The Xianyang Central Hospital from January 2016 to December 2020 were retrospectively reviewed. Results: A total of 4,873 patients (age = 43.8 ± 17.6 years; male = 2,064 [42.4%]) were enrolled in our study. Overall, 2,343 (48.1%) showed positive responses as follows: 1,260 (25.9%) with the mixed type, 34 (0.7%) with the cardioinhibitory type, 580 (11.9%) with the vasodepressor type, 179 (3.7%) with postural tachycardia syndrome (POTS), and 290 (6.0%) with orthostatic hypotension (OH). The study showed that prior to syncope or near-syncope symptoms, patients first presented an increase in heart rate (HR), followed by decreases in blood pressure (BP) and HR successively. Among the patients in the syncope group, the sensitivity of the HUTT was 65.9%, which was significantly higher than a sensitivity of 44.8% for patients in the non-syncope group ( P < 0.01). The sensitivity of the HUTT was higher for females than males in both the syncope group (52.6% in males and 77.9% in females, P < 0.01) and the non-syncope group (36.5% in males and 50.6% in females, P < 0.01). Within the four age groups (<20, 21–40, 41–60, and >60 years old), the sensitivities were 74.7%, 67.7%, 45.6%, and 31.2%, respectively. And all gender, age and symptom (whether suffered from a syncope or not) significantly affected the positive responses of HUTT. There were two adverse events and no deaths during the HUTT in this study. Conclusion: The direct drug-potentiated HUTT is a safe and highly sensitive tool with which to diagnose VVS. Patients with precursor syncope symptoms without syncope should undergo a HUTT, especially young females presenting with weakness and sweating, which can decrease the probability of a misdiagnosis or a missed diagnosis.
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Xu et al. (2022) conducted an observational in Vasovagal syncope (n=4,873). Syncope vs. Precursor syncope (non-syncope) was evaluated on Positive response to head-up tilt test (HUTT) (OR 6.223, 95% CI 5.116-7.595, p=<0.001). Patients with syncope had a significantly higher rate of positive responses to the direct drug-potentiated head-up tilt test compared to patients with precursor syncope (65.9% vs 44.8%, OR 6.223).
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