Head-up tilt test diagnostic yield in syncope diagnosis.

Autor: Barón-Esquivias G; Cardiology Department, Virgen del Rocio University Hospital, Seville University, Spain. Electronic address: gonzalo.baron.sspa@juntadeandalucia.es., Díaz Martín AJ; Cardiology Department, Virgen del Rocio University Hospital, Seville University, Spain., Del Castillo ÁM; Cardiology Department, University Hospital Ramon y Cajal, Madrid, Spain., Quintanilla M; Cardiology Department, Virgen del Rocio University Hospital, Seville University, Spain., Barón-Solís C; Cardiology Department, Virgen del Rocio University Hospital, Seville University, Spain., Morillo CA; Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary and Population Health Research Institute-McMaster University, Hamilton, Ontario, Canada. Electronic address: carlos.morillo@ucalgary.ca.
Jazyk: angličtina
Zdroj: Journal of electrocardiology [J Electrocardiol] 2020 Nov - Dec; Vol. 63, pp. 46-50. Date of Electronic Publication: 2020 Oct 11.
DOI: 10.1016/j.jelectrocard.2020.09.016
Abstrakt: Background: The European Syncope Guidelines (ESG) recommend the use of Head-up tilt test (HUT) in case of suspicion of vasovagal syncope (VVS) or orthostatic hypotensive syncope (OHS) after an adequate initial inconclusive evaluation. We report a single center experience in the scenario of suspected VVS or OHS, who underwent HUT in patients referred to a Syncope Clinic after ruling out high-risk causes.
Methods: We prospectively and consecutively included all syncopal patients that were referred for HUT, by their attending physician after performing a series of diagnostic tests to rule out cardiac etiology. The clinical history and diagnostic tests performed were reviewed prior to HUT. Patients were pre-classified according to the recommendations from the ESG as; VVS, OHS or Syncope of Unknown Etiology (SUE).
Results: We studied 1058 patients, 558 (52.7%) males, mean age 46.5 ± 20.1 yr. There were no gender differences in age, risk factors, previous heart diseases, ECG findings or number of previous tests. Based on the ESG criteria a significant number of diagnostic tests were probably unnecessarily performed. HUT was positive in 609 patients (57.5%). The rate of positive HUT according to pre-classification was significantly different among groups: 60% VVS, 46.1% OHS and 54.3% SUE (p = 0.037). Combining ESG recommendations and HUT results of the 1058 resulted in 762 (72%) diagnosed as VVS, 89 (8.4%) as OHS and 207 (19.5%) as SUE.
Conclusions: Appropriate application of ESG recommendations combined with HUT, identified 81% of patients with non-cardiogenic syncope, potentially avoiding a significant number of unnecessary diagnostic tests.
Competing Interests: Declaration of Competing Interest None.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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