Syncope Unit, Division of Geriatrics and Intensive Care Unit, University of Florence and Careggi Hospital, Largo Brambilla 3, 50139 Florence, Italy.
Department of Clinical Sciences, Lund University, Malmö, Sweden.
Europace. 2021 Jul 18;23(7):1100-1105. doi: 10.1093/europace/euab024.
Tilt testing (TT) is recognized to be a valuable contribution to the diagnosis and the pathophysiology of vasovagal syncope (VVS). This study aimed to assess the influence of age on TT responses by examination of a large patient cohort.
Retrospective data from three experienced European Syncope Units were merged to include 5236 patients investigated for suspected VVS by the Italian TT protocol. Tilt testing-positivity rates and haemodynamics were analysed across age-decade subgroups. Of 5236 investigated patients, 3129 (60%) had a positive TT. Cardioinhibitory responses accounted for 16.5% of positive tests and were more common in younger patients, decreasing from the age of 50-59 years. Vasodepressor (VD) responses accounted for 24.4% of positive tests and prevailed in older patients, starting from the age of 50-59. Mixed responses (59.1% of cases) declined slightly with increasing age. Overall, TT positivity showed a similar age-related trend (P = 0.0001) and was significantly related to baseline systolic blood pressure (P < 0.001). Tilt testing was positive during passive phase in 18% and during nitroglycerine (TNG)-potentiated phase in 82% of cases. Positivity rate of passive phase declined with age (P = 0.001), whereas positivity rate during TNG remained quite stable. The prevalence of cardioinhibitory and VD responses was similar during passive and TNG-potentiated TT, when age-adjusted.
Age significantly impacts the haemodynamic pattern of TT responses, starting from the age of 50. Conversely, TT phase-passive or TNG-potentiated-does not significantly influence the type of response, when age-adjusted. Vagal hyperactivity dominates in younger patients, older patients show tendency to vasodepression.
倾斜试验（TT）被认为是对血管迷走性晕厥（VVS）的诊断和病理生理学有重要贡献。本研究旨在通过检查大量患者队列来评估年龄对 TT 反应的影响。
回顾性数据来自三个有经验的欧洲晕厥单位，合并了 5236 名根据意大利 TT 方案因疑似 VVS 而接受检查的患者。分析了各年龄组的 TT 阳性率和血液动力学变化。在 5236 名接受检查的患者中，3129 名（60%）TT 阳性。心动过缓反应占阳性试验的 16.5%，在年轻患者中更为常见，从 50-59 岁年龄组开始减少。血管抑制反应占阳性试验的 24.4%，在老年患者中更为常见，从 50-59 岁年龄组开始。混合反应（59.1%的病例）随着年龄的增长略有下降。总体而言，TT 阳性率呈现出相似的年龄相关趋势（P = 0.0001），与基线收缩压显著相关（P < 0.001）。在 18%的病例中，TT 在被动阶段阳性，在 82%的病例中，TT 在硝酸甘油（TNG）增强阶段阳性。被动阶段阳性率随年龄增长而下降（P = 0.001），而 TNG 增强阶段阳性率则相当稳定。在年龄调整后，被动和 TNG 增强 TT 期间，心动过缓反应和血管抑制反应的发生率相似。
年龄从 50 岁开始显著影响 TT 反应的血液动力学模式。相反，在年龄调整后，TT 被动或 TNG 增强阶段并不显著影响反应类型。在年轻患者中，迷走神经亢进占主导地位，老年患者倾向于血管抑制。
