Podoleanu C, Frigy A, Dobreanu D, Micu S, Podoleanu Doina, Incze A, Caraşca E
Fourth Medical Clinic, University of Medicine and Pharmacy, Târgu-Mureş, Romania.
Rom J Intern Med. 2004;42(3):585-94.
Syncope is defined as a transient, self-limited loss of consciousness. It is an important cause of morbidity in general population and the vasovagal syncope (VVS) is a common clinical problem which often leads to hospital admission, multiple office visits, and performing of many diagnostic tests. Head-up tilt table testing (HUTT) is a widely used diagnostic tool, with proved efficiency in diagnosing the many types of VVS. The aim of our study was to assess the efficacy of the HUTT with sublingual nitroglycerin (NTG) challenge for the diagnosis of vasovagal syncope.
The study groups consisted of 72 patients (37 women, 35 men), mean age (+/-SD) 38.5 +/- 15.7 years, referred to our clinic for syncope of unknown origin and 16 healthy volunteers as control subjects (9 women and 7 men) with a mean age 26 +/- 6.5 years and no history of syncope. The HUTT protocol was performed in the morning after an overnight fast, with a 15 minutes supine equilibration phase followed by a 30 minutes drug free tilt phase at an angle of 70 degrees. If no positive response was recorded, 400 micrograms of NTG spray were given sublingually and the HUTT continued for 20 minutes.
The HUTT was positive in 58 patients (80.5%) and negative in 14 (19.5%) while in the control subjects 4 (25%) had positive HUTT response. The sensitivity of the HUTT protocol with nitroglycerin challenge used in our study was 81% and the specificity was 75% (p<0.0001).
The described HUTT protocol appears to be a simple and efficient tool for the diagnosis of syncope associated with normal ECG and no signs of organic heart disease. The sublingual nitroglycerin challenge was safe to use and showed no side effects while keeping the sensitivity and specificity of the test to an accepted level.
晕厥被定义为短暂的、自限性意识丧失。它是普通人群发病的一个重要原因，而血管迷走性晕厥（VVS）是一个常见的临床问题，常导致住院、多次门诊就诊以及进行多项诊断检查。头高位倾斜试验（HUTT）是一种广泛使用的诊断工具，在诊断多种类型的VVS方面已证明其有效性。我们研究的目的是评估舌下含服硝酸甘油（NTG）激发试验的HUTT对血管迷走性晕厥的诊断效果。
研究组由72例患者（37例女性，35例男性）组成，平均年龄（±标准差）38.5±15.7岁，因不明原因晕厥转诊至我们的诊所，另有16名健康志愿者作为对照受试者（9例女性和7例男性），平均年龄26±6.5岁，无晕厥病史。HUTT方案在禁食过夜后的早晨进行，先有15分钟的仰卧平衡期，然后以70度角进行30分钟的无药倾斜期。如果未记录到阳性反应，则舌下给予400微克NTG喷雾剂，HUTT继续进行20分钟。
HUTT在58例患者中呈阳性（80.5%），14例呈阴性（19.5%），而在对照受试者中，4例（25%）HUTT反应呈阳性。我们研究中使用的硝酸甘油激发试验的HUTT方案的敏感性为81%，特异性为75%（p<0.0001）。
所描述的HUTT方案似乎是诊断与正常心电图及无器质性心脏病体征相关的晕厥简单而有效的工具。舌下含服硝酸甘油激发试验使用安全，无副作用，同时将试验的敏感性和特异性保持在可接受水平。
