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Comparison of a Shortened Isosorbide Dinitrate-Potentiated Head-Up Tilt Testing with the Conventional Protocol: Tolerance and Diagnostic Accuracy.
- Source :
-
Pacing & Clinical Electrophysiology . Aug2012, Vol. 35 Issue 8, p1005-1011. 7p. - Publication Year :
- 2012
-
Abstract
- Background: The head-up tilt test (HUT) is widely used to investigate unexplained syncope; however, in clinical practice, it is long and sometimes not well tolerated. Objectives: To compare the sensitivity, specificity, accuracy, and patients' tolerance of a conventional and shortened HUT. Methods: Patients with a history of vasovagal syndrome (VVS) were randomized to a conventional HUT (group I) consisting of 20-minute passive tilt followed by 25 minutes after administration of sublingual isosorbide dinitrate (ISDN), or a shortened HUT (group II) where ISDN was given immediately after tilt and observed for 25 minutes. The control group consisted of age- and gender-matched subjects without VVS symptoms. A specific questionnaire to evaluate tolerance was applied. Results: Sixty patients (29 ± 10 years, 82% female) were included. In group I, 22/30 patients had a positive HUT compared to 21/30 in group II (73% vs 70%, P = 0.77). There was also no difference in the accuracy between the two protocols (63% vs 73%, P = 0.24). The time to positivity was shorter in group II (13.2 minutes vs 30 minutes, P < 0.001). Within the control group (n = 60), the frequency of false-positives was 47% and 23% for the conventional and shortened HUT, respectively (P = 0.058). After conventional HUT, 65.2% subjects reported that the test was too long compared to 25% subjects after the shortened HUT (P = 0.002). Conclusion: In this study, the HUT without passive phase was not inferior to the conventional HUT regarding sensitivity, specificity, and accuracy. Furthermore, the shortened ISDN-potentiated protocol allowed faster diagnosis and was better tolerated. (PACE 2012; 35:1005-1011) [ABSTRACT FROM AUTHOR]
- Subjects :
- *SYNCOPE diagnosis
*DIAGNOSIS
*AUTONOMIC nervous system diseases
*SYMPTOMS
*BLOOD pressure
*CHI-squared test
*DIAGNOSTIC errors
*ELECTROCARDIOGRAPHY
*FISHER exact test
*HEART beat
*RESEARCH methodology
*MEDICAL cooperation
*MEDICAL protocols
*QUESTIONNAIRES
*RESEARCH
*STATISTICAL sampling
*STATISTICAL hypothesis testing
*STATISTICS
*T-test (Statistics)
*DATA analysis
*RANDOMIZED controlled trials
*CONTROL groups
*ISOSORBIDE dinitrate (Drug)
*DATA analysis software
*DESCRIPTIVE statistics
*SUBLINGUAL drug administration
*TILT-table test
*DISEASE risk factors
VAGUS nerve diseases
RESEARCH evaluation
Subjects
Details
- Language :
- English
- ISSN :
- 01478389
- Volume :
- 35
- Issue :
- 8
- Database :
- Academic Search Index
- Journal :
- Pacing & Clinical Electrophysiology
- Publication Type :
- Academic Journal
- Accession number :
- 78323497
- Full Text :
- https://doi.org/10.1111/j.1540-8159.2012.03440.x