Noormand Rezvan, Shafiee Akbar, Davoodi Gholamreza, Tavakoli Fatemeh, Gheini Alireza, Yaminisharif Ahmad, Jalali Arash, Sadeghian Saeed
Tehran Heart Center, Tehran University of Medical Sciences, Tehran, IR Iran.
Res Cardiovasc Med. 2015 Sep 15;4(4):e27871. doi: 10.5812/cardiovascmed.27871. eCollection 2015 Nov.
The head-up tilt test (HUTT) is a useful diagnostic tool for syncope.
We sought to investigate the outcome of the HUTT in syncope patients and identify the relationship between age and different hemodynamic outcomes.
In this cross-sectional study, we prospectively enrolled consecutive patients who presented with syncope and underwent the HUTT with a clinical suspicion of neurocardiogenic syncope after the exclusion of orthostatic hypotension cases. The HUTT consisted of consecutive passive and active phases. In the passive phase, the patients were tilted at 70 degrees for 20 minutes; and if negative, the test was repeated with 400 micrograms of sublingual nitroglycerin for another 20 minutes. Positive responses were classified according to the classification of the vasovagal syncope international study (VASIS) and compared for age and gender.
A total of 498 patients were enrolled (age = 44.93 ± 18.77 years; male = 271 [54.4%]). Overall, 291 (58.4%) patients had a positive HUTT, while 256 (88.5%) patients had a positive result during the active phase. The test results were as follows: 107 (36.7%) mixed type (VASIS I), 103 (35.3%) cardioinhibitory (VASIS IIA = 44 [15.1%]; VASIS IIB = 59 [20.2%]), and 80 (27.4%) vasodepressive (VASIS III). There was no relationship between gender and syncope type. The trend of the HUTT result significantly changed with age, and the rate of cardioinhibitory syncope decreased after middle ages (P value for trend = 0.02).
Hemodynamic response to the HUTT was associated with age. Cardioinhibitory response became less frequent with age due to exaggerated vagal activity in the younger patients as compared with the older subjects.
头高位倾斜试验（HUTT）是一种用于晕厥的有用诊断工具。
我们试图研究晕厥患者的HUTT结果，并确定年龄与不同血流动力学结果之间的关系。
在这项横断面研究中，我们前瞻性纳入了连续出现晕厥且在排除体位性低血压病例后因临床怀疑神经心源性晕厥而接受HUTT的患者。HUTT包括连续的被动和主动阶段。在被动阶段，患者倾斜至70度持续20分钟；如果结果为阴性，则舌下含服400微克硝酸甘油再重复测试20分钟。阳性反应根据血管迷走性晕厥国际研究（VASIS）的分类进行分类，并比较年龄和性别。
共纳入498例患者（年龄=44.93±18.77岁；男性=271例[54.4%]）。总体而言，291例（58.4%）患者HUTT结果为阳性，而256例（88.5%）患者在主动阶段结果为阳性。测试结果如下：107例（36.7%）混合型（VASIS I），103例（35.3%）心脏抑制型（VASIS IIA=44例[15.1%]；VASIS IIB=59例[20.2%]），80例（27.4%）血管抑制型（VASIS III）。性别与晕厥类型之间无相关性。HUTT结果的趋势随年龄显著变化，中年后心脏抑制型晕厥的发生率降低（趋势P值=0.02）。
HUTT的血流动力学反应与年龄相关。与老年受试者相比，年轻患者因迷走神经活动过度，心脏抑制型反应随年龄增长而减少。
