Tags

Type your tag names separated by a space and hit enter

Late hemodynamic changes during a negative passive head-up tilt predict the symptomatic outcome to a nitroglycerin sensitized tilt.
Pacing Clin Electrophysiol. 2005 Feb; 28(2):89-96.PC

Abstract

BACKGROUND

Sublingual nitroglycerin is advocated to sensitize the passive 70 degrees head-upright tilt test (HUTT) of patients with unexplained syncope. We hypothesized that a detailed analysis of hemodynamic responses recorded during a negative HUTT could predict the outcome to a subsequent nitroglycerin sensitized HUTT (NTG-HUTT).

METHODS

Thirty-two patients (46 +/- 3 years, 17 males) with recurrent unexplained syncope but a negative HUTT were included. Heart rate, arterial blood pressure, and central hemodynamics assessed by transthoracic impedance (preejection and rapid left ventricular ejection time, slow ejection time, peak amplitude of first derivative, and cardiac index) were recorded during supine rest and 45 minutes HUTT. Changes from supine rest of the variables were retrospectively compared between patients with a negative (n = 15, NTG-HUTT(-)) and positive (n = 17, NTG-HUTT(+)) outcome to 10 minutes subsequent NTG-HUTT.

RESULT

Significant differences between groups were observed during the 15th-20th minutes (Italian protocol) and during the last 5 minutes of passive HUTT (Westminster protocol). The combination of cutoff values, determined by receiver operating curves, on hemodynamic variables changes during the last 5 minutes predicted the outcome to a NTG-HUTT with a sensitivity of 76% and a specificity of 87%. The cutoff values determined during 15th-20th minutes gave an attractive sensitivity (85%) but a too weak specificity (53%) to shorten the 45 minutes passive HUTT at 20 minutes.

CONCLUSION

Outcome to a NTG-HUTT can be reliably predicted by selected criteria determined from multiple hemodynamic variables recorded during a passive 70 degrees HUTT.

Authors+Show Affiliations

Bellard E
Laboratoire de Physiologie, Faculté de Médecine, Angers Cedex, France.
Fortrat JO
No affiliation info available
Schang D
No affiliation info available
Dupuis JM
No affiliation info available
Victor J
No affiliation info available
Lefthériotis G
No affiliation info available

MeSH

Analysis of VarianceBlood PressureCardiography, ImpedanceFemaleHeart RateHemodynamicsHumansMaleMiddle AgedNitroglycerinPredictive Value of TestsROC CurveRetrospective StudiesSensitivity and SpecificityStatistics, NonparametricSupine PositionSyncopeTilt-Table TestVasodilator Agents

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15679637

Citation

Bellard, Elisabeth, et al. "Late Hemodynamic Changes During a Negative Passive Head-up Tilt Predict the Symptomatic Outcome to a Nitroglycerin Sensitized Tilt." Pacing and Clinical Electrophysiology : PACE, vol. 28, no. 2, 2005, pp. 89-96.
Bellard E, Fortrat JO, Schang D, et al. Late hemodynamic changes during a negative passive head-up tilt predict the symptomatic outcome to a nitroglycerin sensitized tilt. Pacing Clin Electrophysiol. 2005;28(2):89-96.
Bellard, E., Fortrat, J. O., Schang, D., Dupuis, J. M., Victor, J., & Lefthériotis, G. (2005). Late hemodynamic changes during a negative passive head-up tilt predict the symptomatic outcome to a nitroglycerin sensitized tilt. Pacing and Clinical Electrophysiology : PACE, 28(2), 89-96.
Bellard E, et al. Late Hemodynamic Changes During a Negative Passive Head-up Tilt Predict the Symptomatic Outcome to a Nitroglycerin Sensitized Tilt. Pacing Clin Electrophysiol. 2005;28(2):89-96. PubMed PMID: 15679637.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Late hemodynamic changes during a negative passive head-up tilt predict the symptomatic outcome to a nitroglycerin sensitized tilt. AU - Bellard,Elisabeth, AU - Fortrat,Jacques-Olivier, AU - Schang,Daniel, AU - Dupuis,Jean-Marc, AU - Victor,Jacques, AU - Lefthériotis,Georges, PY - 2005/2/1/pubmed PY - 2005/6/3/medline PY - 2005/2/1/entrez SP - 89 EP - 96 JF - Pacing and clinical electrophysiology : PACE JO - Pacing Clin Electrophysiol VL - 28 IS - 2 N2 - BACKGROUND: Sublingual nitroglycerin is advocated to sensitize the passive 70 degrees head-upright tilt test (HUTT) of patients with unexplained syncope. We hypothesized that a detailed analysis of hemodynamic responses recorded during a negative HUTT could predict the outcome to a subsequent nitroglycerin sensitized HUTT (NTG-HUTT). METHODS: Thirty-two patients (46 +/- 3 years, 17 males) with recurrent unexplained syncope but a negative HUTT were included. Heart rate, arterial blood pressure, and central hemodynamics assessed by transthoracic impedance (preejection and rapid left ventricular ejection time, slow ejection time, peak amplitude of first derivative, and cardiac index) were recorded during supine rest and 45 minutes HUTT. Changes from supine rest of the variables were retrospectively compared between patients with a negative (n = 15, NTG-HUTT(-)) and positive (n = 17, NTG-HUTT(+)) outcome to 10 minutes subsequent NTG-HUTT. RESULT: Significant differences between groups were observed during the 15th-20th minutes (Italian protocol) and during the last 5 minutes of passive HUTT (Westminster protocol). The combination of cutoff values, determined by receiver operating curves, on hemodynamic variables changes during the last 5 minutes predicted the outcome to a NTG-HUTT with a sensitivity of 76% and a specificity of 87%. The cutoff values determined during 15th-20th minutes gave an attractive sensitivity (85%) but a too weak specificity (53%) to shorten the 45 minutes passive HUTT at 20 minutes. CONCLUSION: Outcome to a NTG-HUTT can be reliably predicted by selected criteria determined from multiple hemodynamic variables recorded during a passive 70 degrees HUTT. SN - 0147-8389 UR - https://www.unboundmedicine.com/medline/citation/15679637/Late_hemodynamic_changes_during_a_negative_passive_head_up_tilt_predict_the_symptomatic_outcome_to_a_nitroglycerin_sensitized_tilt_ DB - PRIME DP - Unbound Medicine ER -