Kurbaan A S, Franzén A C, Bowker T J, Williams T R, Kaddoura S, Petersen M E, Sutton R
St Mary's Hospital, Imperial College School of Medicine, University of London, United Kingdom.
Am J Cardiol. 1999 Sep 15;84(6):665-70. doi: 10.1016/s0002-9149(99)00413-0.
This study assesses the vasovagal collapse pattern changes, i.e, heart rate (HR) and arterial blood pressure (BP) with a 2-stage tilt-test protocol using glyceryl trinitrate (GTN) provocation. With use of the 45-minute 60 degrees head-up Westminster protocol, 102 consecutive patients were studied. Sublingual GTN 300 microg was given to those with a negative passive tilt. Heart rate and BP patterns were classified according to the Vasovagal International Study classification (VASIS) and then compared between those with a positive passive tilt and those with a positive tilt after having been given GTN. Twelve patients did not tolerate tilt testing, and 16 had a negative response despite taking GTN. Thirty-five patients (20 women and 15 men, mean age 45 +/- 21 years [mean +/- SD]) did not take GTN and 38 (26 women and 12 men, mean age 53 +/- 22 years) had positive passive test results. When comparing the VASIS classification between the 2 groups, results showed: type 1, mixed BP and HR decreased without severe bradycardia (31% [passive] vs 54% [with GTN], p = NS); type 2A, BP decreased before HR decreased (20% vs 22%, p = NS); type 2B, HR decreased before or coincident with BP (34% vs 8%, p = 0.003); type 3, BP decreased without HR decrease (9% vs 0%, p = NS); exception 1, chronotropic incompetence (0% vs 13%, p = 0.026); and exception 2, excessive HR increase (6% vs 3%, p = NS). Thus, GTN use increases frequency of positive results from 34% to 73%. Older people with chronotropic incompetence, who may benefit from pacing, were identified. In younger people there was an increase in those with cardioinhibition.
本研究采用两阶段倾斜试验方案，使用硝酸甘油（GTN）激发，评估血管迷走性晕厥模式的变化，即心率（HR）和动脉血压（BP）。采用45分钟60度头高位威斯敏斯特方案，对102例连续患者进行了研究。对被动倾斜试验阴性的患者给予舌下含服300微克GTN。根据血管迷走性国际研究分类（VASIS）对心率和血压模式进行分类，然后比较被动倾斜试验阳性患者和给予GTN后倾斜试验阳性患者之间的差异。12例患者无法耐受倾斜试验，16例患者尽管服用了GTN仍呈阴性反应。35例患者（20名女性和15名男性，平均年龄45±21岁[平均±标准差]）未服用GTN，38例（26名女性和12名男性，平均年龄53±22岁）被动试验结果为阳性。比较两组之间的VASIS分类时，结果显示：1型，血压和心率混合下降且无严重心动过缓（31%[被动]对54%[服用GTN后]，p=无显著性差异）；2A型，血压在心率下降之前下降（20%对22%，p=无显著性差异）；2B型，心率在血压下降之前或与血压下降同时下降（34%对8%，p=0.003）；3型，血压下降而心率不下降（9%对0%，p=无显著性差异）；例外1，变时性功能不全（0%对13%，p=0.026）；例外2，心率过度增加（6%对3%，p=无显著性差异）。因此，使用GTN可使阳性结果的频率从34%增加到73%。识别出了可能从起搏中获益的变时性功能不全的老年人。在年轻人中，心脏抑制患者有所增加。
