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Responses to Tilt test in young and elderly patients with syncope of unknown origin.
Biomed Pharmacother. 2004 Oct; 58(8):443-6.BP

Abstract

The aim of the present study was to assess the cardiovascular autonomic function and responses to tilt test in young and elderly patients with syncope of unknown origin. We evaluated two groups of patients with previous unexplained syncope: 192 older subjects (112 males, 80 females, mean age 67.2 +/- 6.8 years) and 188 young subjects (102 males, 86 females, mean age 25 +/- 9 years). All patients underwent ambulatory electrocardiogram (ECG) monitoring, to evaluate time domain indices of heart rate variability (HRV), and head-up tilt test in the morning after an overnight fast. The responses of positive tilt test were classified using the VAsovagal Syncope International Study (VASIS) criteria: mixed (VASIS-1), cardioinhibition (VASIS-2A), severe cardioinhibition/asystole (VASIS-2B), pure vasodepression (VASIS-3). All the time-domain HRV indexes were lower in the older than in young subjects. The rate of positive responses was not different in the two groups. In elderly group the positive head-up tilt test responses showed: a pure vasodepressive response (VASIS 3) in 126 patients (65%), a mixed (VASIS-1) response in 25 patients (13%), a cardioinhibitory (VASIS-2A) response in 13 patients (7%). Only 28 (14.6%) of elderly group patients had negative head-up tilt test response. In contrast, in young group the positive head-up tilt test responses showed: 114 patients (61.2%) a mixed (VASIS-1) vasovagal response, 40 patients (22.3%) a cardioinhibitory (VASIS-2A) response, four (2.1%) patients a severe cardioinhibitory (VASIS-2B) and four (2.1%) patients a pure vasodepression (VASIS-3) response, respectively. The tilt test was negative in response in 26 young patients (12.2%). Our results confirm that the head-up tilt test may be useful in assessing unexplained syncope, since it is seen to be positive in 85% of elderly patients and 86% in young patients. In our subjects, vasodepressive response was the most frequent cause of syncope in older subjects, while vasovagal response is the commonest cause of syncope of young patients. This different behaviour in the elderly may be is explained with physiological aging, which is associated with a reduction of sympathetic-parasympathetic control on the cardiac rhythm, demonstrated by reduction in all the time domain HRV indices.

Authors+Show Affiliations

Galetta F
Department of Internal Medicine, University of Pisa, Via Roma 67, 56126, Pisa, Italy. fgaletta@med.unipi.it
Franzoni F
No affiliation info available
Femia FR
No affiliation info available
Prattichizzo F
No affiliation info available
Bartolomucci F
No affiliation info available
Santoro G
No affiliation info available
Carpi A
No affiliation info available

MeSH

AdultAgedAgingBlood PressureBody Mass IndexElectrocardiographyFemaleHeart RateHumansMalePostureSyncopeTilt-Table Test

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

15464873

Citation

Galetta, Fabio, et al. "Responses to Tilt Test in Young and Elderly Patients With Syncope of Unknown Origin." Biomedicine & Pharmacotherapy = Biomedecine & Pharmacotherapie, vol. 58, no. 8, 2004, pp. 443-6.
Galetta F, Franzoni F, Femia FR, et al. Responses to Tilt test in young and elderly patients with syncope of unknown origin. Biomed Pharmacother. 2004;58(8):443-6.
Galetta, F., Franzoni, F., Femia, F. R., Prattichizzo, F., Bartolomucci, F., Santoro, G., & Carpi, A. (2004). Responses to Tilt test in young and elderly patients with syncope of unknown origin. Biomedicine & Pharmacotherapy = Biomedecine & Pharmacotherapie, 58(8), 443-6.
Galetta F, et al. Responses to Tilt Test in Young and Elderly Patients With Syncope of Unknown Origin. Biomed Pharmacother. 2004;58(8):443-6. PubMed PMID: 15464873.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Responses to Tilt test in young and elderly patients with syncope of unknown origin. AU - Galetta,Fabio, AU - Franzoni,Ferdinando, AU - Femia,Francesca Romana, AU - Prattichizzo,Fernando, AU - Bartolomucci,Francesco, AU - Santoro,Gino, AU - Carpi,Angelo, PY - 2004/07/22/received PY - 2004/10/7/pubmed PY - 2005/1/26/medline PY - 2004/10/7/entrez SP - 443 EP - 6 JF - Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie JO - Biomed Pharmacother VL - 58 IS - 8 N2 - The aim of the present study was to assess the cardiovascular autonomic function and responses to tilt test in young and elderly patients with syncope of unknown origin. We evaluated two groups of patients with previous unexplained syncope: 192 older subjects (112 males, 80 females, mean age 67.2 +/- 6.8 years) and 188 young subjects (102 males, 86 females, mean age 25 +/- 9 years). All patients underwent ambulatory electrocardiogram (ECG) monitoring, to evaluate time domain indices of heart rate variability (HRV), and head-up tilt test in the morning after an overnight fast. The responses of positive tilt test were classified using the VAsovagal Syncope International Study (VASIS) criteria: mixed (VASIS-1), cardioinhibition (VASIS-2A), severe cardioinhibition/asystole (VASIS-2B), pure vasodepression (VASIS-3). All the time-domain HRV indexes were lower in the older than in young subjects. The rate of positive responses was not different in the two groups. In elderly group the positive head-up tilt test responses showed: a pure vasodepressive response (VASIS 3) in 126 patients (65%), a mixed (VASIS-1) response in 25 patients (13%), a cardioinhibitory (VASIS-2A) response in 13 patients (7%). Only 28 (14.6%) of elderly group patients had negative head-up tilt test response. In contrast, in young group the positive head-up tilt test responses showed: 114 patients (61.2%) a mixed (VASIS-1) vasovagal response, 40 patients (22.3%) a cardioinhibitory (VASIS-2A) response, four (2.1%) patients a severe cardioinhibitory (VASIS-2B) and four (2.1%) patients a pure vasodepression (VASIS-3) response, respectively. The tilt test was negative in response in 26 young patients (12.2%). Our results confirm that the head-up tilt test may be useful in assessing unexplained syncope, since it is seen to be positive in 85% of elderly patients and 86% in young patients. In our subjects, vasodepressive response was the most frequent cause of syncope in older subjects, while vasovagal response is the commonest cause of syncope of young patients. This different behaviour in the elderly may be is explained with physiological aging, which is associated with a reduction of sympathetic-parasympathetic control on the cardiac rhythm, demonstrated by reduction in all the time domain HRV indices. SN - 0753-3322 UR - https://www.unboundmedicine.com/medline/citation/15464873/Responses_to_Tilt_test_in_young_and_elderly_patients_with_syncope_of_unknown_origin_ DB - PRIME DP - Unbound Medicine ER -