Key result
A 5-minute supine rest before nitroglycerin during tilt testing fails to improve diagnostic yield.
Why the study?
Does adding a 5-minute supine resting phase before nitroglycerin administration improve the diagnostic yield of head-up tilt testing in patients with unexplained syncope?
RCT (n=370)
Does adding a 5-minute supine resting phase before nitroglycerin administration improve the diagnostic yield of head-up tilt testing in patients with unexplained syncope?
Absolute Event Rate: 61% vs 60%
p-value: p=0.127
Adding a 5-minute supine resting phase before nitroglycerin administration during head-up tilt testing does not improve diagnostic yield in patients with unexplained syncope.
No benefit from adding supine rest before nitroglycerin during tilt testing; reinforces standard protocol without modification for unexplained syncope.
BACKGROUND: This randomized study was aimed to compare the diagnostic value of two head-up tilt testing protocols using sublingual nitroglycerin for provocation in patients with recurrent unexplained syncope and normal heart. METHODS: The patients with normal findings in physical examination, electrocardiography and echocardiography were randomly submitted to one of upright tilt test protocols. The only difference between two protocols was that nitroglycerin was administered after a five minute resting phase in supine position during protocol B. We also considered eighty normal persons as the control group. RESULTS: Out of 290 patients that underwent tilt testing, 132 patients were in group A versus 158 patients in group B. Both groups had an identical distribution of clinical characteristics. Tilt test was positive in 79 patients in group A (25 in passive phase, 54 in active phase) versus 96 patients in group B (43 in passive phase, 53 in active phase). There was no significant difference between results in two groups (P value= 0.127). Forty cases were tested with protocol A and forty underwent tilt testing with protocol B. Tilt test was positive in 4 cases with protocol A versus 3 cases in protocol B. The positive rates of tilt testing with protocol A was 60% while it was 61% in protocol B. The specificity of testing with protocol A was 90% and it was 92.5% in protocol B. CONCLUSIONS: According to our data, adding a period of rest and returning to supine position before nitroglycerin administration had no additional diagnostic yield.
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Alasti et al. (2013) conducted an RCT in Recurrent unexplained syncope with normal heart (n=370). Protocol B (5-minute supine rest before nitroglycerin) vs. Protocol A (standard upright tilt test) was evaluated on Positive tilt test rate (diagnostic yield) (p=0.127). A 5-minute supine resting phase before nitroglycerin administration during head-up tilt testing did not significantly improve diagnostic yield compared to the standard protocol (61% vs 60%; P=0.127).
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