Tilt-table testing in syncope - our results

    Authors

    Keywords

    tilt-table test, syncope, transient loss of consciousness

    DOI

    https://doi.org/10.15836/ccar2017.378

    Full Text

    Introduction : Syncope is defined as transient, self-limited loss of consciousness due to temporary global cerebral hypoperfusion, resulting from low peripheral resistance and/or low cardiac output ( 1 ). Reported incidence of syncope is high; 18-40 per 1,000 patient-years in general population ( 2 ). Tilt-table testing enables reproduction and characterization of syncope in controlled settings, according to blood pressure and heart rate response to tilting. Modified VASIS classification to tilt testing distinguishes: reflex/vasodepressor syncope, cardioinhibitory syncope with/without asystole, mixed syncope, orthostatic hypotension and POTS (postural orthostatic tachycardia syndrome) ( 3 ). Patients and Methods : We retrospectively analyzed 708 patients (67% female, 33% male) who underwent tilt-table testing in our institution from 2013 to September 2017. Of the referred patients 47.6% were 15-30 y/o, 29.8% were 30-60 y/o, and 22.6% were >60 y/o. Patient history included syncope in majority of patients - 84.6%, 80.1% and 68.8% of patients <30 y/o, 30-60 y/o, and >60 y/o, respectively. Results : Normal reaction to tilt-up testing was found in 49.3% of young (<30 y/o) vs. 83.1% of elderly patients (>60 y/o). Tilt-up testing provoked syncope in 32.6% of patients <30 y/o in contrast to 10.9% of 30-60 y/o and 11.9% of patients >60 y/o (p<0.001). Majority of positive results were classified as vasodepressor syncope (54.9% in patients <30 y/o vs. 77.8% in >60 y/o, p<0.001), cardioinhibitory response was recorded in 10.5% of patients <30 y/o (22.2% of which had asystole), while none of the elderly patients had such type of response (p=0.003). Mixed syncope was found in 34.5% of young (<30 y/o) vs. 22.2% of elderly (>60 y/o) patients, p<0.001. Conclusion : Our result analysis found majority of positive tilt-table test results in younger patients, while >83% of elderly patients had normal reaction to testing, thus questioning widespread use of tilt-table testing in this age group. Mechanisms underlying syncope should be sought in order to properly diagnose and counsel patients for syncope avoidance. Only a minority of younger patients had cardioinhibitory syncope, and none during four analyzed years required pacemaker implantation. Elderly patients with syncope should be evaluated using alternative diagnostic algorithms.

    Cardiologia Croatica
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    Tilt-table testing in syncope - our results

    Extended Abstract
    Issue9-10
    Published
    Pages378
    PDF via DOIhttps://doi.org/10.15836/ccar2017.378
    tilt-table test
    syncope
    transient loss of consciousness

    Authors

    Lada Bradić*ORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Marina MihajlovićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Arijana CrevarORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Gregor EderORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Kristina KrželjORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Tena JukićUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Ivan BitunjacORCIDCroatia
    Martina Lovrić BenčićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia

    Full Text

    Introduction : Syncope is defined as transient, self-limited loss of consciousness due to temporary global cerebral hypoperfusion, resulting from low peripheral resistance and/or low cardiac output ( 1 ). Reported incidence of syncope is high; 18-40 per 1,000 patient-years in general population ( 2 ). Tilt-table testing enables reproduction and characterization of syncope in controlled settings, according to blood pressure and heart rate response to tilting. Modified VASIS classification to tilt testing distinguishes: reflex/vasodepressor syncope, cardioinhibitory syncope with/without asystole, mixed syncope, orthostatic hypotension and POTS (postural orthostatic tachycardia syndrome) ( 3 ). Patients and Methods : We retrospectively analyzed 708 patients (67% female, 33% male) who underwent tilt-table testing in our institution from 2013 to September 2017. Of the referred patients 47.6% were 15-30 y/o, 29.8% were 30-60 y/o, and 22.6% were >60 y/o. Patient history included syncope in majority of patients - 84.6%, 80.1% and 68.8% of patients <30 y/o, 30-60 y/o, and >60 y/o, respectively. Results : Normal reaction to tilt-up testing was found in 49.3% of young (<30 y/o) vs. 83.1% of elderly patients (>60 y/o). Tilt-up testing provoked syncope in 32.6% of patients <30 y/o in contrast to 10.9% of 30-60 y/o and 11.9% of patients >60 y/o (p<0.001). Majority of positive results were classified as vasodepressor syncope (54.9% in patients <30 y/o vs. 77.8% in >60 y/o, p<0.001), cardioinhibitory response was recorded in 10.5% of patients <30 y/o (22.2% of which had asystole), while none of the elderly patients had such type of response (p=0.003). Mixed syncope was found in 34.5% of young (<30 y/o) vs. 22.2% of elderly (>60 y/o) patients, p<0.001. Conclusion : Our result analysis found majority of positive tilt-table test results in younger patients, while >83% of elderly patients had normal reaction to testing, thus questioning widespread use of tilt-table testing in this age group. Mechanisms underlying syncope should be sought in order to properly diagnose and counsel patients for syncope avoidance. Only a minority of younger patients had cardioinhibitory syncope, and none during four analyzed years required pacemaker implantation. Elderly patients with syncope should be evaluated using alternative diagnostic algorithms.