Gielerak Grzegorz, Cholewa Marian
Klinika Chorób Wewnetrznych i Kardiologii Centralnego Szpitala Klinicznego Wojskowej AM w Warszawie.
Pol Arch Med Wewn. 2002 Jul;108(1):639-46.
Optimal conditions in assessment of diagnostic head-up tilt test (TT) value required classification, which identified reactions with syncope and discreet disturbance of consciousness. The aim of the study was to assess of usefulness TT in diagnosis of syncope of unknown origin investigated by classification, which take into consideration vasovagal and nonvasovagal types of neurocardiogenic reactions. We studied 218 pts (115M, 103F), mean age 39.7 +/- 16.1 and 35.2 +/- 17.7 years (adequately for male and female), with 2 or more syncope on unknown origin in last 6 months. Control group was 84 healthy volunteers (43M, 41F), mean age 37.41 +/- 2.6 years, range 18 to 73 years, with no syncope in anamnesis. All patients and controls underwent a TT in Westminster protocol. In case of negative TT, we performed next 20 min TT with 0.25 mg NTG sublinqualis (TT with NTG). Type of vasovagal syncope was defined according to American Experts Classification described in official guidelines of American College of Cardiology (ACC). In the case of vasovagal syncope, detailed specification of syncope was performed according to VASIS classification (the vasovagal Syncope International Study). Passive TT was positive in 51 (23%) pts. In control group passive TT was positive in 6 (7%) pts. TT with NTG generates syncope in additional 99 (45%) pts resulting in number of diagnosed group to 150 (68%) pts. In control group TT with NTG was positive in additional 21 (25%) pts. False positive TT with NTG was diagnosed in 19 (9%) pts in study group and 11 (13%) in control group. Subpopulation of study group with vasovagal syncope was larger than subpopulation with other, nonvasovagal type of reaction (108 vs. 23; p < 0.0001). Taking into consideration this dual types of reaction (vaso- and nonvasovagal) allowed to reveal that there were no statistical significance between sex, age, type of syncope provocation and defined types of vasovagal reactions. ACC classification in comparison to VASIS criteria, was more sensitive (60% vs. 49%), have better diagnostic value to positive (89% vs. 84%) and negative (44% vs. 39%) result of TT and accuracy of diagnosis (66% vs. 47%) with slightly worse specificity of TT (81% vs. 83%).
评估诊断性直立倾斜试验（TT）值的最佳条件需要进行分类，该分类可识别伴有晕厥和意识轻微障碍的反应。本研究的目的是通过分类评估TT在诊断不明原因晕厥中的有用性，该分类考虑了血管迷走性和非血管迷走性神经心源性反应类型。我们研究了218例患者（115例男性，103例女性），平均年龄分别为39.7±16.1岁和35.2±17.7岁（男性和女性分别对应），在过去6个月内有2次或更多次不明原因晕厥。对照组为84名健康志愿者（43例男性，41例女性），平均年龄37.41±2.6岁，年龄范围为18至73岁 ，既往无晕厥病史。所有患者和对照者均按照威斯敏斯特方案进行TT。若TT结果为阴性，则进行接下来20分钟的含0.25mg硝酸甘油舌下含服的TT（含硝酸甘油TT）。血管迷走性晕厥的类型根据美国心脏病学会（ACC）官方指南中描述的美国专家分类来定义。对于血管迷走性晕厥病例，根据VASIS分类（血管迷走性晕厥国际研究）对晕厥进行详细分类。被动TT在51例（23%）患者中呈阳性。对照组中被动TT在6例（7%）志愿者中呈阳性。含硝酸甘油TT在另外99例（45%）患者中诱发晕厥，使诊断组患者数量增至150例（68%）。对照组中含硝酸甘油TT在另外21例（25%）志愿者中呈阳性反应。研究组中有19例（9%）患者和对照组中有11例（13%）志愿者被诊断为含硝酸甘油TT假阳性。研究组中血管迷走性晕厥亚组大于其他非血管迷走性反应亚组（108例对23例；p < 0.0001）。考虑到这两种反应类型（血管迷走性和非血管迷走性），发现性别、年龄、晕厥诱发类型和已定义的血管迷走性反应类型之间无统计学意义。与VASIS标准相比，ACC分类更敏感（60%对49%），对TT阳性（89%对84%）和阴性（44%对39%）结果以及诊断准确性（66%对47%）具有更好的诊断价值，只是TT的特异性稍差（81%对83%）。
