scholarly journals Clinical Significance of the Head-Up Tilt Test in Improving Prognosis in Patients with Possible Neurally Mediated Syncope

Biology ◽  
2021 ◽  
Vol 10 (9) ◽  
pp. 919
Author(s):  
Kengo Ayabe ◽  
Tomoyoshi Komiyama ◽  
Misaki Hasegawa ◽  
Tetsuri Sakai ◽  
Masahiro Morise ◽  
...  
Keyword(s):  
Clinical Significance ◽  
Clinical Information ◽  
University Hospital ◽  
Tilt Test ◽  
Cardiac Events ◽  
Clinical Events ◽  
Neurally Mediated Syncope ◽  
Significant Difference ◽  
Head Up Tilt ◽  
Head Up Tilt Test

Syncope is commonly encountered in daily clinical practice. Depending on its etiology (benign or life-threatening conditions or environmental triggers), syncope can be neurally mediated (reflex), cardiac, or orthostatic. Furthermore, neurologic disease can cause symptoms that mimic syncope. However, there is limited research on neurally mediated syncope (NMS), which is considered a benign disorder, and close follow-ups are rarely performed. NMS can cause serious clinical events, including severe trauma and car accidents. The head-up tilt test (HUTT) is the gold standard for diagnosing NMS; however, its clinical significance remains unknown, and its relevance to NMS prognosis requires further research. This retrospective study aimed to assess the clinical significance of the HUTT for NMS. We reviewed the charts of 101 patients who underwent HUTT at Tokai University Hospital in Japan between January 2016 and March 2019. During the HUTT, 72 patients (69.2%) experienced syncope. Patients were followed up for 886.1 ± 457.7 days (interquartile range: 518–1293 days). The syncope recurrence rate was 16.9%; however, no significant difference was observed between the two groups (HUTT positive vs. negative) (13.8% vs. 18.1%, p = 0.772). Four of 29 (13.9%) and two of 72 (2.8%) patients in the negative and positive HUTT groups, respectively, experienced cardiac events (p = 0.019). Negative HUTT results may assist in anticipating unexpected clinical events within a few years. A negative HUTT result may allow us to reconsider the NMS diagnosis based on clinical information. Close outpatient follow-up of patients with negative HUTT results is warranted.

Neurally mediated syncope detected by carotid sinus massage and head-up tilt test in sick sinus syndrome

1991 ◽  
Vol 68 (10) ◽  
pp. 1032-1036 ◽  
Author(s):  
Michele Brignole ◽  
Carlo Menozzi ◽  
Lorella Gianfranchi ◽  
Daniele Oddone ◽  
Gino Lolli ◽  
...  
Keyword(s):  
Carotid Sinus ◽  
Sick Sinus Syndrome ◽  
Tilt Test ◽  
Carotid Sinus Massage ◽  
Neurally Mediated Syncope ◽  
Head Up Tilt ◽  
Head Up Tilt Test

Role of endogenous opioids in syncope induced by head-up tilt test and its relationship with isoproterenol-dependent and isoproterenol-independent neurally-mediated syncope

1998 ◽  
Vol 67 (3) ◽  
pp. 211-218 ◽  
Author(s):  
Matı́as Pérez-Paredes ◽  
Francisco Picó-Aracil ◽  
Teo Fuentes-Jiménez ◽  
José G Sánchez-Villanueva ◽  
Elena Expósito-Ordoñez ◽  
...  
Keyword(s):  
Endogenous Opioids ◽  
Tilt Test ◽  
Neurally Mediated Syncope ◽  
Head Up Tilt ◽  
Head Up Tilt Test

scholarly journals SHORT HEAD-UP TILT TEST

2012 ◽  
Vol 19 (04) ◽  
pp. 428-432
Author(s):  
HUMAIRA FAYYAZ KHAN ◽  
MUHAMMAD AMJAD HAMEED ◽  
KAMAL SALEEM ◽  
Ayyaz Ahmed ◽  
Nida Naeem
Keyword(s):  
Orthostatic Intolerance ◽  
Armed Forces ◽  
Cross Sectional Study ◽  
Tilt Test ◽  
Test Protocol ◽  
Cross Sectional ◽  
Stabilization Phase ◽  
Neurally Mediated Syncope ◽  
Head Up Tilt ◽  
Head Up Tilt Test

Objective: The aim of the present study was to evaluate the time to syncope in Nitroglycerine potentiated short Head-up tilt test.Study Design, Settings & Duration: This was a descriptive cross sectional study conducted in Armed Forces Institute of cardiology from May2006 to May, 2007. Patients and methods: A total number of 90 patients with orthostatic intolerance both male and female were studied.Head-up tilt test protocol consisted of a Stabilization phase which lasted for five minutes Passive tilt phase: Patients were tilted at 70̊ fororthostatic stress for 15 minutes. In case of no symptoms the test continued with the drug provocation phase which lasted for 15 minutes. Thepatients were administered 400μg of nitroglycerine sublingually in aerosol preparation. Development of symptoms were noted at 5, 10 and 15minutes. Results: A total number of 90 patients were examined during the study period. The tilt table test was classified as positive in 58.9 % ofpatients and was negative in 41.1%. The test was positive in five patients without the drug provocation (9.4%). The responses were classifiedas positive vasodepressor in 35.8%, 15.09% as mixed and cardioinhibitory 15.09% in patients of neurally mediated syncope. The total time todisplay of symptoms to positivity in HUTT was 17.89± 6.99. The mean time to syncope after the administration of nitroglycerine was 5.61± 4.17minutes. Conclusions: Our study concludes that the drug administered phase can be reduced to 12±3 minutes.

scholarly journals Diagnosis and prevention of the vasodepressor type of neurally mediated syncope in Japanese patients

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0251450
Author(s):  
Misaki Hasegawa ◽  
Tomoyoshi Komiyama ◽  
Kengo Ayabe ◽  
Susumu Sakama ◽  
Tetsuri Sakai ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Adenylate Cyclase ◽  
Systolic Blood Pressure ◽  
Healthy Volunteers ◽  
Cyclase Activity ◽  
Adenylate Cyclase Activity ◽  
Tilt Test ◽  
Neurally Mediated Syncope ◽  
Head Up Tilt ◽  
Head Up Tilt Test

We investigated circulatory dynamics in patients with vasodepressor type neurally mediated syncope (VT-NMS) by performing high-resolution Holter electrocardiography and a correlation analysis of changes in adenylate cyclase activity, blood pressure, and pulse during the head-up tilt test. Holter electrocardiography was performed for 30 patients. Adenylate cyclase activity was evaluated in lymphocytes from blood samples taken at rest and during the head-up tilt test. There was no change in autonomic nerve fluctuation during electrocardiography in VT-NMS patients, but our results showed a significant difference in blood pressure and adenylate cyclase activity between VT-NMS patients and healthy volunteers; the systolic blood pressure of VT-NMS patients decreased after 5 min, while at 10 min, the adenylate cyclase activity was the highest (0.53%) and the systolic blood pressure was the lowest (111.8 mm Hg). Pulse rates increased after 10 min. VT-NMS patients showed higher blood pressure, pulse rate, and adenylate cyclase activity during the tilt test than did healthy volunteers. In patients with syncope, standing for longer than 10 minutes may increase the risk of VT-NMS. From our results, we consider it likely that high systolic blood pressure and adenylate cyclase activity at rest cause fainting in VT-NMS patients. Our findings may be helpful for identifying individuals with a high risk of developing NMS in the healthy population.

scholarly journals Changes in arginine-vasopressin and catecholamine during neurally mediated syncope induced by head-up tilt test.

1998 ◽  
Vol 18 (4) ◽  
pp. 424-432 ◽  
Author(s):  
Haruyuki Nakagawa ◽  
Youichi Kobayashi ◽  
Makoto Shinohara ◽  
Chiaki Obara ◽  
Akira Miyata ◽  
...  
Keyword(s):  
Arginine Vasopressin ◽  
Tilt Test ◽  
Neurally Mediated Syncope ◽  
Head Up Tilt ◽  
Head Up Tilt Test

Tilt angles and positive response of head-up tilt test in children with orthostatic intolerance

2013 ◽  
Vol 25 (1) ◽  
pp. 76-80 ◽  
Author(s):  
Jing Lin ◽  
Yuli Wang ◽  
Todd Ochs ◽  
Chaoshu Tang ◽  
Junbao Du ◽  
...  
Keyword(s):  
Tilt Angle ◽  
Positive Response ◽  
Orthostatic Intolerance ◽  
Vasovagal Syncope ◽  
Tilt Test ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Appearance Time ◽  
Significant Difference ◽  
Head Up Tilt ◽  
Head Up Tilt Test

AbstractThis study aimed at examining three tilt angle-based positive responses and the time to positive response in a head-up tilt test for children with orthostatic intolerance, and the psychological fear experienced at the three angles during head-up tilt test. A total of 174 children, including 76 boys and 98 girls, aged from 4 to 18 years old (mean 11.3±2.8 years old), with unexplained syncope, were randomly divided into three groups, to undergo head-up tilt test at the angles of 60°, 70° and 80°, respectively. The diagnostic rates and times were analysed, and Wong–Baker face pain rating scale was used to access the children’s psychological fear. There were no significant differences in diagnostic rates of postural orthostatic tachycardia syndrome and vasovagal syncope at different tilt angles during the head-up tilt test (p>0.05). There was a significant difference, however, in the psychological fear at different tilt angles utilising the Kruskal–Wallis test (χ2=36.398, p<0.01). It was mildest at tilt angle 60° utilising the Kolmogorov–Smirnov test (p<0.01). A positive rank correlation was found between the psychological fear and the degree of tilt angle (rs=0.445, p<0.01). Positive response appearance time was 15.1±14.0 minutes at 60° for vasovagal syncope children. There was no significant difference in the time to positive response, at different tilt angles during the head-up tilt test for vasovagal syncope or for postural orthostatic tachycardia syndrome. Hence, it is suggested that a tilt angle of 60° and head-up tilt test time of 45 minutes should be suitable for children with vasovagal syncope.

Hemodynamic parameters and baroreflex sensitivity during head-up tilt test in patients with neurally mediated syncope

2017 ◽  
Vol 40 (12) ◽  
pp. 1454-1461 ◽  
Author(s):  
Sung Ho Lee ◽  
Ji Hyun Yang ◽  
Hye Ran Yim ◽  
Jungwae Park ◽  
Seung-Jung Park ◽  
...  
Keyword(s):  
Baroreflex Sensitivity ◽  
Tilt Test ◽  
Hemodynamic Parameters ◽  
Neurally Mediated Syncope ◽  
Head Up Tilt ◽  
Head Up Tilt Test

scholarly journals Clinical Factors Affecting a Response of Head-Up Tilt Test in Suspected Neurally Mediated Syncope

2011 ◽  
Vol 27 (Supplement) ◽  
pp. PE4_064
Author(s):  
Joon Hyouk Choi ◽  
Dae Kyung Cho ◽  
Seung-Jung Park ◽  
Hye Ran Yim ◽  
Young Keun On ◽  
...  
Keyword(s):  
Tilt Test ◽  
Clinical Factors ◽  
Factors Affecting ◽  
Neurally Mediated Syncope ◽  
Head Up Tilt ◽  
Head Up Tilt Test

scholarly journals Age is a predictor for the recurrence of syncope in vasovagal syncope patients with a positive head-up tilt test

2019 ◽  
Author(s):  
Yongjuan Guo ◽  
Xiaomin Chen ◽  
Tianze Zeng ◽  
Lin Wang ◽  
Lvwei Cen
Keyword(s):  
Confidence Interval ◽  
Vasovagal Syncope ◽  
Predictive Performance ◽  
Tilt Test ◽  
Logistics Regression ◽  
Increased Risk ◽  
Significant Difference ◽  
Valid Predictor ◽  
Head Up Tilt ◽  
Head Up Tilt Test

Abstract BACKROUND Valid predictors of the recurrence of syncope in vasovagal syncope(VVS) patients with a positive head-up tilt test (HUTT) are currently lacking. The goal of this study was to identify the predictive performance of age for the recurrence of syncope in VVS patients with a positive HUTT.METHODS in total, 175 VVS patients with a positive HUTT were followed for 6 to 32 months, and ≥1 syncope episodes during follow-up was considered the recurrence of syncope. The study population was divided into 2 groups, namely, a recurrence of syncope group (44 patients) and a no recurrence of syncope group (131 patients). The baseline clinical data, hemodynamic parameters and classification of the vasovagal syncope on the HUTT were analyzed. Logistics regression was used to analyze the effect size and confidence interval of age. A receiver operating characteristic(ROC) analysis was used to assess the predictive performance and investigate the predictive value of age by the area under the curve (AUC).RESULTS The age of recurrence of syncope group 60.0 (47.8, 66.0) years was older than that of no recurrence of syncope group 53.0 (43.0, 62.0) years, and there was a significant difference between the two groups (P < 0.05). The trend of syncope recurrence changed with age and the logistics regression model adjusted by sex showed that the elder was an increased risk of syncope recurrence in VVS with positive HUTT [OR value: 1.03, 95% confidence interval(CI) 1.008 to 1.061 p < 0.05].Age was a valid predictor for the recurrence of syncope in VVS patients with a positive HUTT (AUC: 0.688; 95%CI 0.598 to 0.777 p < 0.05). The cut-off value was 53.5 years, and the sensitivity and specificity were 72.7% and 52.7%, respectively. CONCLUSIONS Age may be a valid predictor for recurrence of syncope in VVS patients with positive HUTT. The rate of recurrence of syncope increased with increasing age, especially in old female.

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