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Head-up tilt table testing with low dose sublingual isosorbide dinitrate in the evaluation of unexplained syncope: a comparison with isoproterenol infusion.
Can J Cardiol. 2002 Aug; 18(8):853-9.CJ

Abstract

OBJECTIVES

To investigate the value of head-up tilt table testing (HUTT) with low-dose isosorbide dinitrate (ISDN) in the evaluation of patients with unexplained syncope and to compare the results of HUTT with ISDN and HUTT with isoproterenol.

PATIENTS AND METHODS

Forty-three patients with unexplained syncope (21 women, with a mean age of 45.4 18 years) and 18 control subjects without syncope (eight women, with a mean age of 45.8 12 years) were tilted (80) for 30 min (passive period). When this period was negative, 2.5 mg sublingual ISDN was administered and patients were observed for an additional 15 min (ISDN period). The first 25 patients studied (10 women, with a mean age of 46.2 18 years) were tested again after a mean period of three weeks using the isoproterenol protocol. After the passive period, intravenous isoproterenol was administered (1 to 3 g/min) to patients lying in the supine position, and they were tilted again (80) for 10 min (isoproterenol period).

RESULTS

During the passive period, 10 of 43 patients (23%) had a positive response compared with none in the control group. Syncope was observed in another 14 patients and in two control subjects during the ISDN period. The positivity rate (sensitivity) and specificity of HUTT with low dose ISDN were 56% and 89%, respectively. Among the patients (n=25) tested with the isoproterenol protocol, 14 (56%) patients had syncope. The agreement rate between the protocols was 78.9%.

CONCLUSIONS

The total positivity rate of HUTT significantly increased with the use of the low dose ISDN, while specificity remained high. Due to its simplicity and tolerability, the ISDN protocol can be chosen when the results of the passive period tilt testing are negative.

Authors+Show Affiliations

Aslan O
Department of Cardiology, Dokuz Eylül University, School of Medicine, Izmir, Turkey. ozgur.aslan@deu.edu.tr
Guneri S
No affiliation info available
Badak O
No affiliation info available
Kirimli O
No affiliation info available
Goldeli O
No affiliation info available
Keskin V
No affiliation info available
Akdeniz B
No affiliation info available
Tekin U
No affiliation info available

MeSH

Administration, SublingualAdultCardiovascular AgentsFemaleHumansInfusions, IntravenousIsoproterenolIsosorbide DinitrateMaleMiddle AgedSensitivity and SpecificitySyncopeSyncope, VasovagalTilt-Table Test

Pub Type(s)

Clinical Trial
Comparative Study
Controlled Clinical Trial
Journal Article

Language

eng

PubMed ID

12215748

Citation

Aslan, Ozgur, et al. "Head-up Tilt Table Testing With Low Dose Sublingual Isosorbide Dinitrate in the Evaluation of Unexplained Syncope: a Comparison With Isoproterenol Infusion." The Canadian Journal of Cardiology, vol. 18, no. 8, 2002, pp. 853-9.
Aslan O, Guneri S, Badak O, et al. Head-up tilt table testing with low dose sublingual isosorbide dinitrate in the evaluation of unexplained syncope: a comparison with isoproterenol infusion. Can J Cardiol. 2002;18(8):853-9.
Aslan, O., Guneri, S., Badak, O., Kirimli, O., Goldeli, O., Keskin, V., Akdeniz, B., & Tekin, U. (2002). Head-up tilt table testing with low dose sublingual isosorbide dinitrate in the evaluation of unexplained syncope: a comparison with isoproterenol infusion. The Canadian Journal of Cardiology, 18(8), 853-9.
Aslan O, et al. Head-up Tilt Table Testing With Low Dose Sublingual Isosorbide Dinitrate in the Evaluation of Unexplained Syncope: a Comparison With Isoproterenol Infusion. Can J Cardiol. 2002;18(8):853-9. PubMed PMID: 12215748.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Head-up tilt table testing with low dose sublingual isosorbide dinitrate in the evaluation of unexplained syncope: a comparison with isoproterenol infusion. AU - Aslan,Ozgur, AU - Guneri,Sema, AU - Badak,Ozer, AU - Kirimli,Onder, AU - Goldeli,Ozhan, AU - Keskin,Vehip, AU - Akdeniz,Bahri, AU - Tekin,Umit, PY - 2002/9/7/pubmed PY - 2002/9/26/medline PY - 2002/9/7/entrez SP - 853 EP - 9 JF - The Canadian journal of cardiology JO - Can J Cardiol VL - 18 IS - 8 N2 - OBJECTIVES: To investigate the value of head-up tilt table testing (HUTT) with low-dose isosorbide dinitrate (ISDN) in the evaluation of patients with unexplained syncope and to compare the results of HUTT with ISDN and HUTT with isoproterenol. PATIENTS AND METHODS: Forty-three patients with unexplained syncope (21 women, with a mean age of 45.4 18 years) and 18 control subjects without syncope (eight women, with a mean age of 45.8 12 years) were tilted (80) for 30 min (passive period). When this period was negative, 2.5 mg sublingual ISDN was administered and patients were observed for an additional 15 min (ISDN period). The first 25 patients studied (10 women, with a mean age of 46.2 18 years) were tested again after a mean period of three weeks using the isoproterenol protocol. After the passive period, intravenous isoproterenol was administered (1 to 3 g/min) to patients lying in the supine position, and they were tilted again (80) for 10 min (isoproterenol period). RESULTS: During the passive period, 10 of 43 patients (23%) had a positive response compared with none in the control group. Syncope was observed in another 14 patients and in two control subjects during the ISDN period. The positivity rate (sensitivity) and specificity of HUTT with low dose ISDN were 56% and 89%, respectively. Among the patients (n=25) tested with the isoproterenol protocol, 14 (56%) patients had syncope. The agreement rate between the protocols was 78.9%. CONCLUSIONS: The total positivity rate of HUTT significantly increased with the use of the low dose ISDN, while specificity remained high. Due to its simplicity and tolerability, the ISDN protocol can be chosen when the results of the passive period tilt testing are negative. SN - 0828-282X UR - https://www.unboundmedicine.com/medline/citation/12215748/Head_up_tilt_table_testing_with_low_dose_sublingual_isosorbide_dinitrate_in_the_evaluation_of_unexplained_syncope:_a_comparison_with_isoproterenol_infusion_ DB - PRIME DP - Unbound Medicine ER -