Key result
Adenosine HUT provides ~47% lower diagnostic yield than ISDN and no significant advantage over ISP.
Why the study?
Does adenosine head-up tilt testing improve the diagnostic yield for neurally mediated syncope compared to isoproterenol or isosorbide dinitrate testing in patients with unexplained syncope?
Observational (n=103)
Does adenosine head-up tilt testing improve the diagnostic yield for neurally mediated syncope compared to isoproterenol or isosorbide dinitrate testing in patients with unexplained syncope?
Absolute Event Rate: 14.7% vs 27.8%
p-value: p=<0.05
Adenosine head-up tilt testing is a rapid and effective alternative for diagnosing neurally mediated syncope, and can induce syncope in some patients who do not respond to isosorbide dinitrate testing.
Adenosine tilt testing shows lower or similar yields versus standard agents; leaves open its role as a rapid alternative pending prospective trials.
Background Head‐up tilt (HUT) testing is used to establish the diagnosis of neurally mediated syncope (NMS). Adenosine administration during HUT testing is useful for inducing NMS. However, no comparison between adenosine HUT testing and HUT testing using other drugs has been reported. The purpose of this study was to investigate the clinical usefulness of adenosine compared with isoproterenol (ISP) and isosorbide (ISDN) during HUT testing. Methods The subjects comprised 103 consecutive patients with unexplained syncope who underwent adenosine and isoproterenol (ISP) HUT tests following a negative response in a drug‐free HUT test. Subjects were first tilted upright at an 80° angle for 30 min and shown to have a negative response in drug‐free HUT test. Subsequently, a continuous bolus of 0.1‐ or 0.2‐mg/kg adenosine was administered while the subjects remained upright and were observed for 5 min (adenosine HUT test). Next, they were tilted upright for 15 min during a continuous infusion of 0.01–0.02 mg/kg min ISP (ISP HUT test). Lastly, they were tilted upright for 15 min after 1.25‐mg ISDN infusion (ISDN HUT test). Results The diagnostic yield of the adenosine HUT test was 18.1% (18/99) and that of the ISP HUT test was 6.0% (6/99; p=N.S.). Sixty‐one of 99 patients underwent ISDN HUT testing, and 17 patients had a positive response. The diagnostic yield of the adenosine HUT test was 14.7% (9/61) and that of ISDN HUT test was 27.8% (p<0.05). Five patients had positive responses in both adenosine and ISDN HUT tests. Conversely, 4 patients had a positive response in the adenosine HUT test and a negative response in the ISDN HUT test. Conclusion The adenosine HUT test was effective in the diagnosis of NMS and is useful as the ISP HUT test for inducing NMS. The diagnostic yield of the adenosine HUT test was not higher than that of the ISDN HUT test. However, the adenosine HUT test took only a few minutes and induced NMS in some of the patients in whom NMS was not induced by the ISDN HUT test. Therefore, performing adenosine HUT testing is worthwhile.
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Watanabe et al. (2014) conducted an observational in Unexplained syncope (n=103). Adenosine head-up tilt (HUT) test vs. Isosorbide dinitrate (ISDN) HUT test was evaluated on Diagnostic yield for neurally mediated syncope (p=<0.05). Adenosine head-up tilt testing had a diagnostic yield of 18.1% vs 6.0% for isoproterenol (p=N.S.) and 14.7% vs 27.8% for isosorbide dinitrate (p<0.05) in patients with unexplained syncope.
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