Glockler Antonia, Cismaru Gabriel, Istratoaie Sabina, Gusetu Gabriel, Zdrenghea Dumitru, Pop Dana, Rosu Radu
5th Department of Internal Medicine, Cardiology-Rehabilitation, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
Medicine (Baltimore). 2020 Mar;99(11):e19510. doi: 10.1097/MD.0000000000019510.
Performing a head-up tilt test can be of great value for the diagnosis of vasovagal syncope. The European Society of Cardiology recommends a drug challenge phase duration of 15 to 20 minutes, with either Isoprenaline or Nitroglycerin administration.We sought to investigate the outcome of a ten-minute active phase with Nitroglycerin in patients suspected of vasovagal syncope and determine the percentage of loss in the positivity rate, using this short duration approach.We consecutively enrolled patients presenting with syncope undergoing the head-up tilt test (HUTT), with a clinical suspicion of vasovagal syncope between the years 2009 to 2019. The HUTT consisted of 2 successive phases: passive and active. During the passive phase, the patients were tilted at 70° for 20 minutes. If negative, the test was continued after administration of 0.4 mg sublingual Nitroglycerin. Applying the (VASIS) Vasovagal Syncope International Study classification of the vasovagal syncope international study and comparing for age and gender, positive responses were categorized into 3 types.A number of 306 patients (age = 43.5 +/-20.3; male = 140 [45.7%]) with suspected vasovagal syncope, undergoing HUTT, were enrolled in the years of 2009 to 2019. Of those, 245 (80.2%) presented a positive test, with 200 patients (82.0%) during the being positive during the active phase of the test. The results were as follows: 116 subjects (47.2%) presented with a mixed response (VASIS I), 52 (21.3%) showed a cardio inhibitory response (VASIS II), and 77 (31.5%) displayed a vasodepressor response (VASIS III). We found no relationship between the type of syncope with neither gender, nor age of the patient. Three minutes represented the median time to positivity, after Nitroglycerine administration. The time distribution showed a peak incidence appearing between minutes 3 and 5, ranging from 1 to 20 minutes. Only 3 patients tested positive after minute 10.Shortening the active phase to 10 minutes would result in a positivity rate loss of 1.5%.
进行直立倾斜试验对血管迷走性晕厥的诊断具有重要价值。欧洲心脏病学会建议使用异丙肾上腺素或硝酸甘油进行药物激发试验的持续时间为15至20分钟。我们试图研究对疑似血管迷走性晕厥患者采用10分钟硝酸甘油激发试验的结果，并确定采用这种短时间方法时阳性率的损失百分比。
我们连续纳入了2009年至2019年间因晕厥接受直立倾斜试验（HUTT）且临床怀疑为血管迷走性晕厥的患者。HUTT包括两个连续阶段：被动阶段和主动阶段。在被动阶段，患者以70°倾斜20分钟。如果结果为阴性，则在舌下含服0.4毫克硝酸甘油后继续试验。应用血管迷走性晕厥国际研究（VASIS）的血管迷走性晕厥分类，并比较年龄和性别，阳性反应分为3种类型。
2009年至2019年间，共有306例疑似血管迷走性晕厥的患者接受了HUTT（年龄=43.5±20.3；男性=140例[45.7%]）。其中，245例（80.2%）试验结果为阳性，200例（82.0%）在试验的主动阶段呈阳性。结果如下：116例受试者（47.2%）表现为混合反应（VASIS I型），52例（21.3%）表现为心脏抑制反应（VASIS II型），77例（31.5%）表现为血管减压反应（VASIS III型）。我们发现晕厥类型与患者的性别和年龄均无关联。硝酸甘油给药后，出现阳性反应的中位时间为3分钟。时间分布显示，阳性反应的高峰出现在第3至5分钟之间，范围为1至20分钟。只有3例患者在第10分钟后试验结果为阳性。
将主动阶段缩短至10分钟会导致阳性率损失1.5%。
