Comparison of a Shortened Isosorbide Dinitrate-Potentiated Head-Up Tilt Testing with the Conventional Protocol: Tolerance and Diagnostic Accuracy

被引:7
作者
Macedo, Paula G. [2 ,3 ]
Asirvatham, Samuel J. [1 ,4 ]
Maia, Leila [5 ]
Ferreira Neto, Eustaquio [3 ]
Zanatta, Andre [5 ]
Sobral Neto, Jose [3 ]
Barreto, Jose Roberto [3 ,5 ]
Maia, Henrique [3 ]
Oliveira, Edna M. [3 ,6 ]
Da Rocha, Jairo M. [3 ,6 ]
Margalho, Carla S. [3 ]
Seixas, Tamer [3 ]
Peres, Ayrton [7 ]
Santos-Neto, Leopoldo [8 ]
Leite, Luiz R. [5 ,6 ]
机构
[1] Mayo Clin, Coll Med, Div Cardiovasc Dis, Rochester, MN 55905 USA
[2] Univ Brasilia, Dept Med Sci, Braslia, Brazil
[3] Hosp Base Dist Fed, Dept Cardiol, Braslia, Brazil
[4] Mayo Clin, Dept Pediat & Adolescent Med, Rochester, MN 55905 USA
[5] Hosp Brasilia, Dept Cardiol, Braslia, Brazil
[6] Clin Biocardios, Dept Cardiol, Brasilia, DF, Brazil
[7] Ritmocardio, Brasilia, DF, Brazil
[8] Univ Brasilia, Dept Internal Med, Braslia, Brazil
来源
PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY | 2012年 / 35卷 / 08期
关键词
Head-up tilt testing; vasovagal syndrome; diagnostic accuracy; syncope; VASOVAGAL SYNCOPE; UNEXPLAINED SYNCOPE; SUBLINGUAL NITROGLYCERIN; GLYCERYL TRINITRATE; MANAGEMENT; ISOPRENALINE; INFUSION; PHASE;
D O I
10.1111/j.1540-8159.2012.03440.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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; 35:10051011)
引用
收藏
页码:1005 / 1011
页数:7
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