Age-related tilt test responses in patients with suspected reflex syncope
(2021) In Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology 23(7). p.1100-1105- Abstract
AIMS: Tilt testing (TT) is recognized to be a valuable contribution to the diagnosis and the pathophysiology of vasovagal syncope (VVS). This study aimed to assess the influence of age on TT responses by examination of a large patient cohort.
METHODS AND RESULTS: Retrospective data from three experienced European Syncope Units were merged to include 5236 patients investigated for suspected VVS by the Italian TT protocol. Tilt testing-positivity rates and haemodynamics were analysed across age-decade subgroups. Of 5236 investigated patients, 3129 (60%) had a positive TT. Cardioinhibitory responses accounted for 16.5% of positive tests and were more common in younger patients, decreasing from the age of 50-59 years. Vasodepressor... (More)
AIMS: Tilt testing (TT) is recognized to be a valuable contribution to the diagnosis and the pathophysiology of vasovagal syncope (VVS). This study aimed to assess the influence of age on TT responses by examination of a large patient cohort.
METHODS AND RESULTS: Retrospective data from three experienced European Syncope Units were merged to include 5236 patients investigated for suspected VVS by the Italian TT protocol. Tilt testing-positivity rates and haemodynamics were analysed across age-decade subgroups. Of 5236 investigated patients, 3129 (60%) had a positive TT. Cardioinhibitory responses accounted for 16.5% of positive tests and were more common in younger patients, decreasing from the age of 50-59 years. Vasodepressor (VD) responses accounted for 24.4% of positive tests and prevailed in older patients, starting from the age of 50-59. Mixed responses (59.1% of cases) declined slightly with increasing age. Overall, TT positivity showed a similar age-related trend (P = 0.0001) and was significantly related to baseline systolic blood pressure (P < 0.001). Tilt testing was positive during passive phase in 18% and during nitroglycerine (TNG)-potentiated phase in 82% of cases. Positivity rate of passive phase declined with age (P = 0.001), whereas positivity rate during TNG remained quite stable. The prevalence of cardioinhibitory and VD responses was similar during passive and TNG-potentiated TT, when age-adjusted.
CONCLUSIONS: Age significantly impacts the haemodynamic pattern of TT responses, starting from the age of 50. Conversely, TT phase-passive or TNG-potentiated-does not significantly influence the type of response, when age-adjusted. Vagal hyperactivity dominates in younger patients, older patients show tendency to vasodepression.
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- author
- Rivasi, Giulia ; Torabi, Parisa LU ; Secco, Gianmarco ; Ungar, Andrea ; Sutton, Richard ; Brignole, Michele and Fedorowski, Artur LU
- organization
- publishing date
- 2021-02-10
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- SYNCOPE
- in
- Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
- volume
- 23
- issue
- 7
- pages
- 1100 - 1105
- publisher
- Oxford University Press
- external identifiers
-
- scopus:85112126072
- pmid:33564843
- ISSN
- 1532-2092
- DOI
- 10.1093/europace/euab024
- language
- English
- LU publication?
- yes
- additional info
- Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com.
- id
- bc17aace-ef28-45e2-935a-e6279853b72b
- date added to LUP
- 2021-02-12 10:16:17
- date last changed
- 2024-09-20 15:45:06
@article{bc17aace-ef28-45e2-935a-e6279853b72b, abstract = {{<p>AIMS: Tilt testing (TT) is recognized to be a valuable contribution to the diagnosis and the pathophysiology of vasovagal syncope (VVS). This study aimed to assess the influence of age on TT responses by examination of a large patient cohort.</p><p>METHODS AND RESULTS: Retrospective data from three experienced European Syncope Units were merged to include 5236 patients investigated for suspected VVS by the Italian TT protocol. Tilt testing-positivity rates and haemodynamics were analysed across age-decade subgroups. Of 5236 investigated patients, 3129 (60%) had a positive TT. Cardioinhibitory responses accounted for 16.5% of positive tests and were more common in younger patients, decreasing from the age of 50-59 years. Vasodepressor (VD) responses accounted for 24.4% of positive tests and prevailed in older patients, starting from the age of 50-59. Mixed responses (59.1% of cases) declined slightly with increasing age. Overall, TT positivity showed a similar age-related trend (P = 0.0001) and was significantly related to baseline systolic blood pressure (P < 0.001). Tilt testing was positive during passive phase in 18% and during nitroglycerine (TNG)-potentiated phase in 82% of cases. Positivity rate of passive phase declined with age (P = 0.001), whereas positivity rate during TNG remained quite stable. The prevalence of cardioinhibitory and VD responses was similar during passive and TNG-potentiated TT, when age-adjusted.</p><p>CONCLUSIONS: Age significantly impacts the haemodynamic pattern of TT responses, starting from the age of 50. Conversely, TT phase-passive or TNG-potentiated-does not significantly influence the type of response, when age-adjusted. Vagal hyperactivity dominates in younger patients, older patients show tendency to vasodepression.</p>}}, author = {{Rivasi, Giulia and Torabi, Parisa and Secco, Gianmarco and Ungar, Andrea and Sutton, Richard and Brignole, Michele and Fedorowski, Artur}}, issn = {{1532-2092}}, keywords = {{SYNCOPE}}, language = {{eng}}, month = {{02}}, number = {{7}}, pages = {{1100--1105}}, publisher = {{Oxford University Press}}, series = {{Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology}}, title = {{Age-related tilt test responses in patients with suspected reflex syncope}}, url = {{http://dx.doi.org/10.1093/europace/euab024}}, doi = {{10.1093/europace/euab024}}, volume = {{23}}, year = {{2021}}, }