Tilt testing positivity in suspected vasovagal syncope varied by age (P=0.0001), with cardioinhibitory responses dominating in younger and vasodepressor responses in older patients.
Observational (n=5,236)
Yes
How does age influence the haemodynamic pattern of tilt testing responses in patients with suspected vasovagal syncope?
Age significantly impacts the haemodynamic pattern of tilt testing responses, with vagal hyperactivity dominating in younger patients and vasodepression in older patients.
p-value: p=0.0001
AIMS: Tilt testing (TT) is recognized to be a valuable contribution to the diagnosis and the pathophysiology of vasovagal syncope (VVS). This study aimed to assess the influence of age on TT responses by examination of a large patient cohort. METHODS AND RESULTS: Retrospective data from three experienced European Syncope Units were merged to include 5236 patients investigated for suspected VVS by the Italian TT protocol. Tilt testing-positivity rates and haemodynamics were analysed across age-decade subgroups. Of 5236 investigated patients, 3129 (60%) had a positive TT. Cardioinhibitory responses accounted for 16.5% of positive tests and were more common in younger patients, decreasing from the age of 50-59 years. Vasodepressor (VD) responses accounted for 24.4% of positive tests and prevailed in older patients, starting from the age of 50-59. Mixed responses (59.1% of cases) declined slightly with increasing age. Overall, TT positivity showed a similar age-related trend (P = 0.0001) and was significantly related to baseline systolic blood pressure (P < 0.001). Tilt testing was positive during passive phase in 18% and during nitroglycerine (TNG)-potentiated phase in 82% of cases. Positivity rate of passive phase declined with age (P = 0.001), whereas positivity rate during TNG remained quite stable. The prevalence of cardioinhibitory and VD responses was similar during passive and TNG-potentiated TT, when age-adjusted. CONCLUSIONS: Age significantly impacts the haemodynamic pattern of TT responses, starting from the age of 50. Conversely, TT phase-passive or TNG-potentiated-does not significantly influence the type of response, when age-adjusted. Vagal hyperactivity dominates in younger patients, older patients show tendency to vasodepression.
Rivasi et al. (Wed,) conducted a observational in suspected reflex syncope (n=5,236). Tilt testing was evaluated on Tilt testing-positivity rates and haemodynamics across age-decade subgroups (p=0.0001). Tilt testing positivity in suspected vasovagal syncope varied by age (P=0.0001), with cardioinhibitory responses dominating in younger and vasodepressor responses in older patients.
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