Key result
Early faint times (<20 minutes) during tilt-table testing were not associated with more severe dysautonomia or age differences compared to late faint times in patients with pure reflex syncope.
Why the study?
Does early faint time on tilt-table test indicate more severe dysautonomia compared to late faint time in patients with reflex syncope?
Observational (n=131)
Does early faint time on tilt-table test indicate more severe dysautonomia compared to late faint time in patients with reflex syncope?
The timing of syncope during a tilt-table test does not correlate with the severity of dysautonomia, but extending the test to 30 minutes significantly increases diagnostic yield.
Early faint timing should not guide dysautonomia severity assumptions in reflex syncope; leaves open whether extended tilt protocols improve diagnostic yield.
OBJECTIVE: The aim of this study was to determine whether patients who faint earlier in the course of a tilt table study represent a separate population with a poorer prognosis or different pathophysiology. We analyzed differences across patients with different syncopal times on the tilt-table study to answer this question. METHODS: This was a retrospective, approved, chart review. From our database of over 6000 patients, we identified 1222 patients with syncope. After excluding patients with orthostatic hypotension, postural tachycardia syndrome and diabetes, we were left with 131 patients with pure reflex syncope. We divided fainters into an early (<20 minutes) and late (>20 minutes) faint times. Along with the tilt table test all patients underwent heart rate response for deep breathing, Valsalva maneuver and quantitative sudomotor axon reflex tests. RESULTS: By 10 minutes in the tilt study, only 18% of subjects had fainted, 65% by 20 minutes, 92% by 30 minutes and 96% by 35 minutes. Age was evenly distributed across all syncopal times. Neither the 14 abnormal cardiac responses to deep breathing nor the 20 abnormal Valsalva maneuvers, nor the 28 abnormal axon reflex responses clustered with an early or late faint time. CONCLUSION: A 10-minute tilt will miss 82% of syncopal episodes, while a 30- minute tilt increases the yield 10-fold, missing only 8%. Patients with early faint times did not differ from patients with late fainting times with regard to age or autonomic test abnormalities. Timing of syncope during the tilt table test does not associated with more severe dysautonomia. A prospective study is needed to confirm these observations.
No takes yet. Share an insight, caveat, or question.
Ulaş et al. (2011) conducted an observational in pure reflex syncope (n=131). Early faint time (<20 minutes) during tilt-table test vs. Late faint time (>20 minutes) was evaluated on Differences in age or autonomic test abnormalities (deep breathing, Valsalva, axon reflex). Early faint times (<20 minutes) during tilt-table testing were not associated with more severe dysautonomia or age differences compared to late faint times in patients with pure reflex syncope.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: