1. Comparison of a Shortened Isosorbide Dinitrate-Potentiated Head-Up Tilt Testing with the Conventional Protocol: Tolerance and Diagnostic Accuracy.
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MACEDO, PAULA G., ASIRVATHAM, SAMUEL J., MAIA, LEILA, NETO, EUSTÁQUIO FERREIRA, ZANATTA, ANDRÉ, NETO, JOSÉ SOBRAL, BARRETO, JOSÉ ROBERTO, MAIA, HENRIQUE, OLIVEIRA, EDNA M., DA ROCHA, JAIRO M., MARGALHO, CARLA S., SEIXAS, TAMER, PERES, AYRTON, SANTOS‐NETO, LEOPOLDO, and LEITE, LUIZ R.
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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 - 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]
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- 2012
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