Key result
ABPM and simplified tilt testing correlate with HUTT responses for diagnosing vasovagal syncope.
Why the study?
The head-up tilt test is widely used but time-consuming and not cost-effective for evaluating patients with vasovagal syncope, prompting investigation of alternatives.
Do ambulatory blood pressure monitoring and the simplistic tilt test predict the presence, pattern, and stage of syncope during the head-up tilt test in patients with vasovagal syncope?
Observational (n=360)
Do ambulatory blood pressure monitoring and the simplistic tilt test predict the presence, pattern, and stage of syncope during the head-up tilt test in patients with vasovagal syncope?
Ambulatory blood pressure monitoring and the simplistic tilt test may serve as promising, cost-effective alternatives to the head-up tilt test for evaluating vasovagal syncope.
May support ABPM ratios and simplified tilt as HUTT alternatives in VVS; hypothesis-generating and requires prospective validation.
Objective: The head-up tilt test (HUTT) is widely used but is time-consuming and not cost-effective to evaluate patients with vasovagal syncope (VVS). The present study aims to verify the hypothesis that ambulatory blood pressure (BP) monitoring (ABPM) and the simplistic tilt test may be potential alternatives to the HUTT. Methods: The study consecutively enrolled 360 patients who underwent the HUTT to evaluate VVS. BP), heart rate (HR), and BP/HR ratios derived from ABPM and the simplistic tilt test were evaluated to predict the presence, pattern, and stage of syncope during the HUTT. Results: Mixed response was the commonest pattern, and syncope occurred frequently with infusion of isoproterenol at a rate of 3 μg/min. During the simplistic tilt test, the cardioinhibitory group had higher tilted BP/HR ratios than the vasodepressor group, while the vasodepressor group had a faster tilted HR and a larger HR difference than the cardioinhibitory group. The higher the BP/HR ratio in the tilted position, the higher the isoproterenol dosage needed to induce a positive response. During ABPM, BP/HR ratios were significantly higher in the cardioinhibitory group than in the vasodepressor group. The higher the ABPM-derived BP, the higher the dosage of isoproterenol needed to induce syncope. There were significant correlations in BP/HR ratios between ABPM and the supine position in the vasodepressor group, while significant correlation was found only for the diastolic BP/HR ratio between ABPM and the tilted position in the cardioinhibitory group. The mixed pattern shared correlative features of the other two patterns. Conclusion: ABPM and the simplistic tilt test might be used as promising alternatives to the HUTT in VVS evaluation in clinical settings.
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Wen et al. (2020) conducted an observational in Vasovagal syncope (n=360). Ambulatory blood pressure monitoring (ABPM) and simplistic tilt test vs. Head-up tilt test (HUTT) was evaluated on Presence, pattern, and stage of syncope during the HUTT. Ambulatory blood pressure monitoring and the simplistic tilt test demonstrated significant correlations with HUTT responses, suggesting they may be promising alternatives for evaluating vasovagal syncope.
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