In patients with unexplained syncope, age and presyncope did not predict overall HUTT positivity, but predicted a vasodepressor response (age OR 1.54; presyncope OR 2.16) and active stage positivity.
Observational (n=640)
What are the predictors of response to head-up tilt testing in patients with unexplained syncope or presyncope?
Older age and presyncope as the presenting symptom predict a vasodepressor and late response to head-up tilt testing in patients with unexplained syncope.
BACKGROUND: Unexplained syncope is a relatively frequent symptom, mostly caused by a neurocardiogenic reaction. The purpose of this study was to determine predictors of response to head-up tilt testing (HUTT) in patients with unexplained syncope or presyncope. METHODS: HUTT was done in 640 consecutive patients with unexplained syncope or presyncope (393 men, mean age 45+/-19 years) after initial workup including history, physical examination, and appropriate laboratory evaluation. RESULTS: Three hundred and forty-four (54%) patients had a positive result. The most common type of response was mixed type (46%) followed by vasodepressor (39%) and cardioinhibitory (15%) types. Age, gender, presence of structural heart disease, baseline heart rhythm, and the presenting symptom before the test failed to predict a positive response to HUTT, but among patients with a positive response to the test, age (OR: 1.54, CI = 1.04-2.47, P = 0.016) and presyncope (OR: 2.16, CI = 1.2-3.85, P = 0.008) as the presenting symptom predicted a vasodepressor type of response. The age (OR: 1.58, CI = 1.29-3.94, P = 0.01) and presyncope (OR: 4.6, CI = 1.74-12.24, P = 0.001) were also predictors for test positivity in the active stage. CONCLUSIONS: There is an age-related gradient in hemodynamic response during neurocardiogenic syncope. The elderly patients more commonly had a vasodepressor and late response, in the active stage, but young subjects more commonly experienced an earlier and cardioinhibitory or mixed responses in the passive stage.
Kazemi et al. (Tue,) conducted a observational in Unexplained syncope or presyncope (n=640). Head-up tilt testing (HUTT) was evaluated on Positive response to head-up tilt testing. In patients with unexplained syncope, age and presyncope did not predict overall HUTT positivity, but predicted a vasodepressor response (age OR 1.54; presyncope OR 2.16) and active stage positivity.