Tags

Type your tag names separated by a space and hit enter

'Front-loaded' head-up tilt table testing: validation of a rapid first line nitrate-provoked tilt protocol for the diagnosis of vasovagal syncope.
Age Ageing. 2008 Jul; 37(4):411-5.AA

Abstract

Head-up tilt testing is the investigation of choice in the diagnosis of vasovagal syncope. The test is time consuming and labour intensive, with conventional tilt testing taking up to 45 min. We compared a shortened 'front-loaded' 20-min glyceryl trinitrate-provoked head-up tilt (FLGTN-HUT) with the standard 40-min passive tilt (HUT) as first line investigations in patients with unexplained syncope and asymptomatic controls. In the study, 149 consecutive patients with unexplained syncope and 83 asymptomatic controls were enrolled. Subjects were randomly assigned to FLGTN-HUT (800 mcg, metred spray) or HUT, then the opposite tilt-test 1 week later. Seventeen (11.4%) patients had diagnostic haemodynamic changes and symptom reproduction during HUT and 54 (36.2%) during FLGTN-HUT. A total of 24.8% more patients had a positive test with FLGTN-HUT than with passive HUT (95% CI: 16.3%, 33.4%). Nine (10.8%) controls had significant haemodynamic changes during HUT and 23 (27.7%) during GTN provocation. Seven controls had haemodynamic changes on both HUT and FLGTN-HUT testing. The controls group had 16.8% more significant haemodynamic changes with FLGTN-HUT than with HUT (95% CI: 0.06, 27.4). The front-loaded GTN protocol provided a higher diagnostic rate than passive tilt testing, and provides a rapid alternative to conventional methods, though false positivity rates are higher.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Parry SW
Falls and Syncope Service and Institute for Ageing and Health, Newcastle University, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK. steve.parry@nuth.nhs.uk
Gray JC
No affiliation info available
Newton JL
No affiliation info available
Reeve P
No affiliation info available
O'Shea D
No affiliation info available
Kenny RA
No affiliation info available

MeSH

AdolescentAdultAgedAged, 80 and overAutonomic Nervous SystemCross-Over StudiesFalse Positive ReactionsFemaleHumansMaleMiddle AgedNitroglycerinReproducibility of ResultsSyncope, VasovagalTilt-Table TestVasodilator Agents

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Validation Study

Language

eng

PubMed ID

18586835

Citation

Parry, Steve W., et al. "'Front-loaded' Head-up Tilt Table Testing: Validation of a Rapid First Line Nitrate-provoked Tilt Protocol for the Diagnosis of Vasovagal Syncope." Age and Ageing, vol. 37, no. 4, 2008, pp. 411-5.
Parry SW, Gray JC, Newton JL, et al. 'Front-loaded' head-up tilt table testing: validation of a rapid first line nitrate-provoked tilt protocol for the diagnosis of vasovagal syncope. Age Ageing. 2008;37(4):411-5.
Parry, S. W., Gray, J. C., Newton, J. L., Reeve, P., O'Shea, D., & Kenny, R. A. (2008). 'Front-loaded' head-up tilt table testing: validation of a rapid first line nitrate-provoked tilt protocol for the diagnosis of vasovagal syncope. Age and Ageing, 37(4), 411-5. https://doi.org/10.1093/ageing/afn098
Parry SW, et al. 'Front-loaded' Head-up Tilt Table Testing: Validation of a Rapid First Line Nitrate-provoked Tilt Protocol for the Diagnosis of Vasovagal Syncope. Age Ageing. 2008;37(4):411-5. PubMed PMID: 18586835.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 'Front-loaded' head-up tilt table testing: validation of a rapid first line nitrate-provoked tilt protocol for the diagnosis of vasovagal syncope. AU - Parry,Steve W, AU - Gray,Janine C, AU - Newton,Julia L, AU - Reeve,Pamela, AU - O'Shea,Diarmuid, AU - Kenny,Rose Anne, PY - 2008/7/1/pubmed PY - 2008/7/31/medline PY - 2008/7/1/entrez SP - 411 EP - 5 JF - Age and ageing JO - Age Ageing VL - 37 IS - 4 N2 - Head-up tilt testing is the investigation of choice in the diagnosis of vasovagal syncope. The test is time consuming and labour intensive, with conventional tilt testing taking up to 45 min. We compared a shortened 'front-loaded' 20-min glyceryl trinitrate-provoked head-up tilt (FLGTN-HUT) with the standard 40-min passive tilt (HUT) as first line investigations in patients with unexplained syncope and asymptomatic controls. In the study, 149 consecutive patients with unexplained syncope and 83 asymptomatic controls were enrolled. Subjects were randomly assigned to FLGTN-HUT (800 mcg, metred spray) or HUT, then the opposite tilt-test 1 week later. Seventeen (11.4%) patients had diagnostic haemodynamic changes and symptom reproduction during HUT and 54 (36.2%) during FLGTN-HUT. A total of 24.8% more patients had a positive test with FLGTN-HUT than with passive HUT (95% CI: 16.3%, 33.4%). Nine (10.8%) controls had significant haemodynamic changes during HUT and 23 (27.7%) during GTN provocation. Seven controls had haemodynamic changes on both HUT and FLGTN-HUT testing. The controls group had 16.8% more significant haemodynamic changes with FLGTN-HUT than with HUT (95% CI: 0.06, 27.4). The front-loaded GTN protocol provided a higher diagnostic rate than passive tilt testing, and provides a rapid alternative to conventional methods, though false positivity rates are higher. SN - 1468-2834 UR - https://www.unboundmedicine.com/medline/citation/18586835/'Front_loaded'_head_up_tilt_table_testing:_validation_of_a_rapid_first_line_nitrate_provoked_tilt_protocol_for_the_diagnosis_of_vasovagal_syncope_ DB - PRIME DP - Unbound Medicine ER -