Guida Pietro, Iacoviello Massimo, Forleo Cinzia, Sorrentino Sandro, Puzzovivo Agata, Rodio Marica, De Pascalis Francesca, Balducci Cataldo, Sarlo Margherita, Favale Stefano
Cardiology Unit, Emergency and Organ Transplantation Department, University of Bari, Piazza Giulio Cesare 11, Bari, Italy.
Pacing Clin Electrophysiol. 2010 Oct;33(10):1210-6. doi: 10.1111/j.1540-8159.2010.02791.x.
To compare head-up tilt testing (HUT) outcomes and hemodynamic responses, and the prevalence and correlates of prodromes, in elderly and younger patients with suspected vasovagal syncope (VVS).
Consecutive outpatients with a history of recurrent unexplained syncope underwent HUT by being tilted to 70°; the test was potentiated by the administration of 300 μg of nitroglycerine after 20 minutes. Occurrence of VVS and hemodynamic responses during passive and nitroglycerine phases of HUT were evaluated; symptoms preceding HUT-induced syncope were recorded, together with heart rate and arterial blood pressure values.
Four hundred and sixty of the 743 patients were HUT positive: 156 fainted during the unmedicated phase and 304 after nitroglycerine administration. The patients aged ≥65 years (n = 102) experienced VVS more frequently during the pharmacological stage of HUT; the overall rate of positive results was similar to that observed in the patients aged 36-64 years (n = 329) and only slightly lower than that observed in those aged ≤ 35 years (n = 312). In the older patients, who experienced fewer and mainly prodrome-free spontaneous syncopal episodes, HUT increased the number of premonitory symptoms, and there were no significant age-related differences in symptom prevalence or timing or the patients' hemodynamic characteristics.
The rate of VVS induced by nitroglycerine-potentiated HUT is similar in elderly and younger patients. In the former, nitroglycerine-potentiated HUT significantly increases the prevalence of prodromes in comparison with spontaneous episodes, which suggests that it may be useful not only for diagnosis but also for patient counseling.
比较老年和年轻疑似血管迷走性晕厥（VVS）患者的头高位倾斜试验（HUT）结果、血流动力学反应以及前驱症状的发生率和相关因素。
连续纳入有不明原因反复晕厥病史的门诊患者，将其倾斜至70°进行HUT；20分钟后给予300μg硝酸甘油以增强试验效果。评估HUT被动期和硝酸甘油期VVS的发生情况及血流动力学反应；记录HUT诱发晕厥前的症状，以及心率和动脉血压值。
743例患者中有460例HUT结果为阳性：156例在未用药阶段晕厥，304例在给予硝酸甘油后晕厥。≥65岁的患者（n = 102）在HUT的药物阶段更频繁地发生VVS；总体阳性率与36 - 64岁患者（n = 329）相似，仅略低于≤35岁患者（n = 312）。老年患者自发晕厥发作次数较少且主要无前驱症状，HUT增加了前驱症状的数量，症状发生率、发作时间或患者血流动力学特征在年龄上无显著差异。
硝酸甘油增强的HUT诱发VVS的发生率在老年和年轻患者中相似。对于老年患者，与自发发作相比，硝酸甘油增强的HUT显著增加了前驱症状的发生率，这表明其不仅对诊断有用，对患者咨询也可能有用。
