Author + information
- Lale Dinç Asarcıklı1,
- Habibe Kafes1,
- Yesim Guray1,
- Umit Guray1,
- Esra Gucuk İpek2,
- Burcu Demirkan1 and
- Ayse Colak1
Background and Aim
Head-up tilt test (HUTT) is frequently used for patients with unexplained syncope. So far, no study conducted in Turkey has evaluated the relationship between clinical features of patients with unexplained syncope and HUTT results. The aim of this study was to assess characteristics of the patients during active and passive stages of HUTT.
Patients with a history of unexplained syncope underwent HUTT. Initially, patients had 10 minutes supine rest and then were tilted up to 70 degrees for 20 minutes. That phase was called "passive phase". Patients who had syncope during passive phase were grouped under the heading of “passive (+)”. At the end of the passive phase, in case of no syncope, 5mg sublingual isosorbiddinitrate was applied to potentiate the HUTT. That phase was called "active phase". Patients who had syncope during active phase were grouped under the heading of “active (+)”. If no symptoms occurred during the active phase, the test was terminated after waiting for 25 minutes. The test was considered (+) if syncope occurred. The syncope types were classified according to Vasovagal Syncope International Study (VASIS) classification: mixed type, cardioinhibitory (CI) type and vasodepressor (VD) type.
We enrolled 205 patients to the study. The mean age was 35.6±15.3 and the mean body mass index (BMI) was 24.0±4.9. Seventy-one percent of the patients were HUTT positive: 135 patients (65.9%) were active (+), 11 patients (5.4%) were passive (+). Of all patients, 4.4% had diabetes, 13.7% had hypertension, 3.9% had coronary artery disease, 19.6% had trauma and 30.4% were current smokers. About eighty-three percent of patients had prodromal symptoms such as dizziness (29.4%), blurred vision (21.6%), palpitation (16.7%), sweating (7.4%) and nausea (5.9%). Mean test duration was 45.3±8.9 minutes (min 10-max 55 minutes). Smokers had more syncope episodes in previous 6 months (p:0.029). According to VASIS classification, 52.7 % of the patients had mixed type, 46.6% had VD type and 0.7% had CI type syncope. There was no gender difference between different VVS types (p:0.241). Patients who had (-) HUTT had higher BMI (p=0.011). Active (+) patients had more history of trauma during a syncopal episode (p:0.040) and had lower diastolic blood pressure (p:0.024). Total HUTT duration was shorter in passive (+) patients (p<0.001). There was no significant difference regarding presence of cardiovascular risk factors and prodromal symptoms between active (+) and passive (+) patients.
In our study, clinical characteristics were not associated with syncope type and HUTT outcome. Patients whose tests were (-), had higher BMI. Active (+) patients had more history of trauma and had lower symptomatic DBP while total HUTT duration was shorter in passive (+) patients.
Keywords: cardioinhibitor, head up tilt test, nitrate, prodrome, vasodepressor, vasovagal syncope
|All patients n:204||Mixed type|
|Cardioinhibitor type VVS|
|Vasodepressor type VVS|
|Baseline SBP (mmHg)||123,8+/-13,8||123,7+/-15,3||128,7+/-16,1||121,2+/-11,9||0,184|
|Baseline DBP (mmHg)||73,3+/-9,9||72,6+/-10,3||73,3+/-9,9||72,6+/-9,5||0,510|
|Symptomatic HR* (n/min)||72,1+/-39,3||43,7+/-14,9||25,0||104,9+/-32,4||0,000|
|Presence of prodromes (%)||82,8||93,2||80,0||81,3||72,4|
|Test duration (minute)||45,3+/-8,9||40,5+/-8,5||42,2+/-6,9||44,0+/-6,9||0,180|
Mean values+/-SD #median (minimum-maximum) HR:Heart Rate SBP:systolic blood pressure DBP:diastolic blood pressure DM: Diabetes HT: hypertension CAD: coronary artery disease *available for 146 symptomatic patients.
|Active HUTT (+)|
|Passive HUTT (+)|
|Baseline SBP (mmHg)||124.5+/-14.5||114,6+/-11,9||0.030|
|Baseline DBP (mmHg)||73.2+/-9,9||67,3+/-5,5||0.055|
|Symptomatic HR (n/min)||73.4+/-39,9||56,0+/-28,9||0.159|
|Symptomatic DBP (mmHg)||40.4+/-13,9||50,6+/-18,3||0.024|
|Presence of prodromes (%)||87.4||81,8||0.596|
|Test duration (minute)||43.8+/-4.2||19.3+/-4.9||0.000|
|Mixed type VVS (%)||51.1||72.7||0.380|
|Cardioinhibitor type VVS (%)||0.7||0,0||0.380|
|Vasodepressor type VVS (%)||48.1||27.3||0.380|
Mean values+/-SD #median (minimum-maximum) HR:Heart Rate SBP:systolic blood pressure DBP:diastolic blood pressure DM: Diabetes HT: hypertension CAD: coronary artery disease