Short-duration head-up tilt test potentiated with sublingual nitroglycerin in suspected vasovagal syncope: the fast Italian protocol.

Autor:	Russo V; Cardiology and Syncope Unit, Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli'-Monaldi Hospital, Piazzale E. Ruggeri, 80126 Naples, Italy., Parente E; Cardiology and Syncope Unit, Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli'-Monaldi Hospital, Piazzale E. Ruggeri, 80126 Naples, Italy., Tomaino M; Division of Cardiology, Ospedale Generale Regionale, Via Lorenz Böhler 5, 39100 Bolzano, Italy., Comune A; Cardiology and Syncope Unit, Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli'-Monaldi Hospital, Piazzale E. Ruggeri, 80126 Naples, Italy., Sabatini A; Division of Cardiology, Ospedale Generale Regionale, Via Lorenz Böhler 5, 39100 Bolzano, Italy., Laezza N; Cardiology and Syncope Unit, Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli'-Monaldi Hospital, Piazzale E. Ruggeri, 80126 Naples, Italy., Carretta D; AOU Policlinico Consorziale di Bari-Ospedale Giovanni XXIII, Coronary Unit and Electrophysiology/Pacing Unit, Cardio-Thoracic Department, Policlinico University Hospital of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy., Nigro G; Cardiology and Syncope Unit, Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli'-Monaldi Hospital, Piazzale E. Ruggeri, 80126 Naples, Italy., Rago A; Cardiology and Syncope Unit, Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli'-Monaldi Hospital, Piazzale E. Ruggeri, 80126 Naples, Italy., Golino P; Cardiology and Syncope Unit, Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli'-Monaldi Hospital, Piazzale E. Ruggeri, 80126 Naples, Italy., Brignole M; IRCCS Istituto Auxologico Italiano, Faint and Fall Research Centre, Cardiology Unit and Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, Piazzale Brescia 20, 20149 Milano, Italy.
Jazyk:	angličtina
Zdroj:	European heart journal [Eur Heart J] 2023 Jul 14; Vol. 44 (27), pp. 2473-2479.
DOI:	10.1093/eurheartj/ehad322
Abstrakt:	Background: The traditional nitroglycerin (NTG) head-up tilt test (HUTT) is time-consuming and the test duration is a barrier to widespread utilization in clinical practice. It was hypothesized that a short-duration protocol is not inferior to the traditional protocol regarding the positivity rate and has a similar distribution of hemodynamic response. Methods and Results: Patients undergoing HUTT were randomized 1:1 to a 10 min passive phase plus a 10 min 0.3 mg NTG if the passive phase was negative (Fast) or to a 20 min passive phase plus a 15 min 0.3 mg NTG if the passive phase was negative (Traditional). A sample size of 277 patients for each group achieved 80% power to detect an expected difference of 0% with a non-inferiority margin of -10% using a one-sided t-test and assuming a significant level alpha of 0.025. A total of 554 consecutive patients (mean age 46.6 ± 19.3 years, 47.6% males) undergoing HUTT for suspected vasovagal syncope were randomly assigned to the Fast (n = 277) or Traditional (n = 277) protocol. A positive response was defined as the induction of syncope in presence of hypotension/bradycardia, and was observed in 167 (60.3%) patients with Fast and in 162 (58.5%) patients with the Traditional protocol. There was a trend of lesser vasodepressor response (14.8% Fast vs. 20.6% Traditional) which was significant during the passive phase (P = 0.01). Conclusion: The diagnostic value of the Fast HUTT protocol is similar to that of the Traditional protocol and therefore the Fast protocol can be used instead of the Traditional protocol. Competing Interests: Conflict of interest All authors declare no conflict of interest for this contribution. (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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