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Titolo:
A randomized study of tilt test angle in patients with undiagnosed syncope
Autore:
Sheldon, R; Koshman, ML;
Indirizzi:
Univ Calgary, Cardiovasc Res Grp, Calgary, AB T2N 4N1, Canada Univ Calgary Calgary AB Canada T2N 4N1 s Grp, Calgary, AB T2N 4N1, Canada
Titolo Testata:
CANADIAN JOURNAL OF CARDIOLOGY
fascicolo: 10, volume: 17, anno: 2001,
pagine: 1051 - 1057
SICI:
0828-282X(200110)17:10<1051:ARSOTT>2.0.ZU;2-O
Fonte:
ISI
Lingua:
ENG
Soggetto:
HEAD-UP TILT; NEURALLY-MEDIATED SYNCOPE; TABLE TEST; NEUROCARDIOGENIC SYNCOPE; UNEXPLAINED SYNCOPE; UNKNOWN ORIGIN; EVALUATING PATIENTS; ISOPROTERENOL; CHILDREN; HYPOTENSION;
Keywords:
bradycardia; diagnosis; hypotension; syncope; tests;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
33
Recensione:
Indirizzi per estratti:
Indirizzo: Sheldon, R Univ Calgary, Cardiovasc Res Grp, 3330 Hosp Dr NW, Calgary, AB T2N 4N1, Canada Univ Calgary 3330 Hosp Dr NW Calgary AB Canada T2N 4N1 , Canada
Citazione:
R. Sheldon e M.L. Koshman, "A randomized study of tilt test angle in patients with undiagnosed syncope", CAN J CARD, 17(10), 2001, pp. 1051-1057

Abstract

BACKGROUND: A widely used tilt test protocol involves passive head-up tiltfollowed by tilt with isoproterenol infusion if necessary. Little is knownabout the effects of passive tilt angle and duration, duration of isoproterenol infusion or hemodynamic diagnostic criteria. OBJECTIVES: To assess whether tilt angle and duration of isoproterenol infusion affected test outcomes in patients with undiagnosed syncope. PATIENTS AND METHODS: Two hundred one syncope patients (87 men, age 45 +/-20 years, median five faints) were randomly assigned to undergo 60 degreesversus 80 degrees tilt for 45 min, then, if necessary, to receive isoproterenol 30 ng/kg/min for 20 min or less. Positive tests ended in presyncope or syncope. RESULTS: Overall, 49% and 71% of patients fainted at 60 degrees and 80 degrees, respectively (P=0.002). In the drug-free stage, 27% and 50% of patients fainted at 60 degrees and 80 degrees, respectively (P=0.0005). In the 119 patients who received isoproterenol, there was no significant difference in the probability of a positive isoproterenol test at 60 degrees and 80 degrees, respectively (31% compared with 43% of exposed patients, P=0.25). Symptoms developed in adults during drug-free tilt linearly with time at both60 degrees and 80 degrees at 0.6% and 1.1%/min, respectively, while symptoms during isoproterenol tilt reached an asymptote after about 10 min. Rate-systolic pressure products of 7000 mmHg/min and 9000 mmHg/min best distinguished positive from negative passive and isoproterenol stages, respectively. CONCLUSIONS: The positive yield of passive tilt tests is higher at 80 degrees and increases linearly with the duration of tilt. A subsequent 10 min isoproterenol infusion maximizes positive yield. Evidence-based outcome criteria accurately distinguish negative from positive tilt tests.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 31/03/20 alle ore 15:57:36