Nitrate-stimulated tilt testing enhances the predictive value of the tilt test on the risk of recurrence in patients with suspected vasovagal syncope

2005 ◽  
Vol 60 (1) ◽  
pp. 15-20 ◽  
Author(s):  
Arnaud J.J. AERTS ◽  
Peter VANDERGOTEN ◽  
Willem R.M. DASSEN ◽  
Paul DENDALE
Keyword(s):  
Predictive Value ◽  
Vasovagal Syncope ◽  
Tilt Test ◽  
Risk Of Recurrence ◽  
Tilt Testing

scholarly journals The predictive value of urine specific gravity in the diagnosis of vasovagal syncope in children and adolescents

2021 ◽  
Vol 47 (1) ◽  
Author(s):  
Ping Liu ◽  
Xingfang Zeng ◽  
Wanzhen Mei ◽  
Yuwen Wang ◽  
Runmei Zou ◽  
...  
Keyword(s):  
Specific Gravity ◽  
Children And Adolescents ◽  
Sensitivity And Specificity ◽  
Roc Curve ◽  
Predictive Value ◽  
Vasovagal Syncope ◽  
Urine Specific Gravity ◽  
Tilt Test ◽  
Control Group ◽  
Neurally Mediated Syncope

Abstract Background Vasovagal syncope (VVS) is a kind of common neurally mediated syncope in children and adolescents. Decreased blood volume is one of the pathogenesis of VVS. The diagnosis of VVS is mainly based on head-up tilt test (HUTT), but some complications may easily occur when HUTT induces syncope. To find a simple and safe VVS diagnosis method can improve the VVS diagnosis efficiency. Aims of the study This was a prospective study. The study will explore the predictive value of urine specific gravity (USG) in the diagnosis of VVS in children and adolescents. Patients and methods Ninety-seven cases (43 males and 54 females, aged 4 to 16 years old, with an average age of 10.91 ± 2.18 years old) hospitalized due to unexplained premonitory syncope or syncope and diagnosed with VVS through HUTT from September 2014 to September 2018 were selected as VVS group. During the same period, 91 cases of children and adolescents, including 45 males and 46 females, aged from 5 to 15 years old, who underwent a healthy examination were matched as a control (control group). USG was measured in both groups. Results The USG of VVS group was significantly lower than that of the control group (P < 0.01), and USG of females was lower than that of males in VVS group (P = 0.045). The sensitivity and specificity of USG in predicting VVS were evaluated by ROC curve. The area under the ROC curve was 0.751, standard error was 0.035, and 95% CI (0.683, 0.819) suggested that USG was of moderate predictive value in the diagnosis of VVS. As cut-off value of USG was 1.0185, the sensitivity and specificity and diagnostic coincidence rate of VVS were 74.39, 66.04 and 69.68%, respectively. Conclusion There are less USG in children and adolescents with VVS, especially lower USG in females. Therefore, USG has predictive value in the diagnosis of VVS in children and adolescents.

Heart rate and blood pressure variability in subjects with vasovagal syncope

2004 ◽  
Vol 107 (1) ◽  
pp. 55-61 ◽  
Author(s):  
Gianfranco PICCIRILLO ◽  
Camilla NASO ◽  
Antonio MOISÈ ◽  
Marco LIONETTI ◽  
Marialuce NOCCO ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Spectral Analysis ◽  
Vasovagal Syncope ◽  
Tilt Test ◽  
Tilt Testing ◽  
Controlled Breathing ◽  
Normalized Units ◽  
Frequency Power ◽  
Rr Variability

Autonomic nervous system control in subjects with vasovagal syncope is controversial. In the present study, we used short-term spectral analysis to evaluate autonomic control in subjects with recurrent vasovagal syncope. We assessed the ability of spectral indices of HR (heart rate) variability to predict tilt-test responses. A series of 47 outpatients with recurrent vasovagal syncope and with positive responses to head-up tilt testing underwent a further study of RR variability during controlled breathing at rest and during tilt testing. During controlled breathing, RR interval variability of total power (TPRR; P<0.001), low-frequency power (LFRR; P<0.05), high-frequency power (HFRR; P<0.001) and HF expressed in normalized units (HFnuRR; P<0.001) were all higher, and LF expressed in normalized units (LFnuRR) and LF/HF ratio were lower in subjects with vasovagal syncope than in controls (P<0.001). To assess the ability of spectral components of RR variability to predict tilt-test responses, we prospectively studied 109 subjects with recurrent vasovagal syncope. The two normalized measures, HFnuRR and LFnuRR, determined during controlled breathing alone predicted a positive tilt-test response (sensitivity, 76%; specificity, 99%; positive predictive value, 96%; and negative predictive value, 90%). During tilting, subjects with vasovagal syncope had lower SBP (systolic blood pressure; P<0.05), LF component of peak SBP variability (LFSBP) and LFnuRR than controls, and higher TPRR, HFRR, HFnuRR and α HF (P<0.001). These spectral data indicate that vagal sinus modulation is increased at rest in subjects with vasovagal syncope. Spectral analysis of RR variability during controlled breathing, a procedure that predicts tilt-test responses, could be a useful guide in choosing the method of tilt testing.

Age-related tilt test responses in patients with suspected reflex syncope

EP Europace ◽  
2021 ◽  
Author(s):  
Giulia Rivasi ◽  
Parisa Torabi ◽  
Gianmarco Secco ◽  
Andrea Ungar ◽  
Richard Sutton ◽  
...  
Keyword(s):  
Older Patients ◽  
Vasovagal Syncope ◽  
Tilt Test ◽  
Valuable Contribution ◽  
Younger Patients ◽  
Tilt Testing ◽  
Age Related ◽  
Large Patient ◽  
Baseline Systolic Blood Pressure ◽  
Passive Phase

Abstract Aims Tilt testing (TT) is recognized to be a valuable contribution to the diagnosis and the pathophysiology of vasovagal syncope (VVS). This study aimed to assess the influence of age on TT responses by examination of a large patient cohort. Methods and results Retrospective data from three experienced European Syncope Units were merged to include 5236 patients investigated for suspected VVS by the Italian TT protocol. Tilt testing-positivity rates and haemodynamics were analysed across age-decade subgroups. Of 5236 investigated patients, 3129 (60%) had a positive TT. Cardioinhibitory responses accounted for 16.5% of positive tests and were more common in younger patients, decreasing from the age of 50–59 years. Vasodepressor (VD) responses accounted for 24.4% of positive tests and prevailed in older patients, starting from the age of 50–59. Mixed responses (59.1% of cases) declined slightly with increasing age. Overall, TT positivity showed a similar age-related trend (P = 0.0001) and was significantly related to baseline systolic blood pressure (P &lt; 0.001). Tilt testing was positive during passive phase in 18% and during nitroglycerine (TNG)-potentiated phase in 82% of cases. Positivity rate of passive phase declined with age (P = 0.001), whereas positivity rate during TNG remained quite stable. The prevalence of cardioinhibitory and VD responses was similar during passive and TNG-potentiated TT, when age-adjusted. Conclusions Age significantly impacts the haemodynamic pattern of TT responses, starting from the age of 50. Conversely, TT phase—passive or TNG-potentiated—does not significantly influence the type of response, when age-adjusted. Vagal hyperactivity dominates in younger patients, older patients show tendency to vasodepression.

Impact of age on the vasovagal response provoked by sublingual nitroglycerine in routine tilt testing

2007 ◽  
Vol 113 (7) ◽  
pp. 329-337 ◽  
Author(s):  
Bart Verheyden ◽  
Janneke Gisolf ◽  
Frank Beckers ◽  
John M. Karemaker ◽  
Karel H. Wesseling ◽  
...  
Keyword(s):  
Vasovagal Syncope ◽  
Study Groups ◽  
Left Ventricular ◽  
Buffering Capacity ◽  
Tilt Test ◽  
Resistance Response ◽  
Baroreflex Control ◽  
Tilt Testing ◽  
Age Related ◽  
Vasovagal Response

NTG (nitroglycerine) is used in routine tilt testing to elicit a vasovagal response. In the present study we hypothesized that with increasing age NTG triggers a more gradual BP (blood pressure) decline due to a diminished baroreflex-buffering capacity. The purpose of the present study was to examine the effect of NTG on baroreflex control of BP in patients with distinct age-related vasovagal collapse patterns. The study groups consisted of 29 patients (16–71 years old, 17 females) with clinically suspected VVS (vasovagal syncope) and a positive tilt test. Mean FAP (finger arterial pressure) was monitored continuously (Finapres). Left ventricular SV (stroke volume), CO (cardiac output) and SVR (systemic vascular resistance) were computed from the pressure pulsations (Modelflow). BRS (baroreflex sensitivity) was estimated in the time domain. In the first 3 min after NTG administration, BP was well-maintained in all patients. This implied an adequate arterial resistance response to compensate for steeper reductions in SV and CO with increasing age. HR (heart rate) increased and the BRS decreased after NTG administration. The rate of mean FAP fall leading to presyncope was inversely related to age (r=0.51, P=0.005). Accordingly, patients with a mean FAP fall >1.44 mmHg/s (median) were generally younger compared with patients with a slower mean FAP-fall (30±10 years compared with 51±17 years; P=0.001). The main determinant of the rate of BP fall on approach of presyncope was the rate of fall in HR (r=0.75, P<0.001). It was concluded that, in older patients, sublingual NTG provokes a more gradual BP decline compared with younger patients. This gradual decline cannot be ascribed to failure of the baroreflex-buffering capacity with increasing age. Age-related differences in the laboratory presentation of a vasovagal episode depend on the magnitude of the underlying bradycardic response.

Comparison of the finger plethysmography derived stroke volumes by Nexfin CO Trek and suprasternal aortic Doppler derived stroke volume measurements in adults with myalgic encephalomyelitis/chronic fatigue syndrome and in healthy controls

2021 ◽  
pp. 1-14
Author(s):  
C. (Linda) M.C. van Campen ◽  
Freek W.A. Verheugt ◽  
Peter C. Rowe ◽  
Frans C. Visser
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Stroke Volume ◽  
Chronic Fatigue ◽  
Calibration Procedure ◽  
Myalgic Encephalomyelitis ◽  
Tilt Test ◽  
Healthy Controls ◽  
Tilt Testing ◽  
Fatigue Syndrome ◽  
Finger Plethysmography

BACKGROUND: Finger plethysmography derived stroke volumes are frequently measured during tilt table testing. There are two algorithms to determine stroke volumes: Modelflow and NexfinCO Trek. Most tilt studies used Modelflow, while there are differences between the two algorithms. OBJECTIVE: To compare stroke volume indices by Nexfin CO Trek (SVINexfinCOTrek) with suprasternal Doppler derived SVI (SVIDoppler) in healthy controls (HC) and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) patients during tilt testing. These patients may have a large SVI decrease during the tilt enabling a large range of SVI to be studied. METHODS: One hundred and fifty-four patients and 39 HC with a normal tilt test were included. Supine and end-tilt SVIDoppler and SVINexfinCOTrek were compared using the Bland-Altman analysis. Also, the effect of calibrating supine SVINexfinCOTrek to SVIDoppler was studied RESULTS: Supine and end-tilt SVINexfinCOTrek were significantly higher than SVIDoppler: both P< 0.005. Bias, limits of agreement, and percent error (PE) were high with PE’s between 37 and 43%. The calibration procedure resulted in an acceptable variance with a PE of 29%. CONCLUSIONS: SVINexfinCOTrek overestimates stroke volumes compared to SVIDoppler, leading to high PE’s. Calibration reduced variance to an acceptable level, allowing SVINexfinCOTrek to be used for assessment of SVI changes during tilt testing

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