Department of Neurology, University Hospital Center Zagreb, Zagreb, Croatia.
School of Medicine, University of Zagreb, Zagreb, Croatia.
Neurol Sci. 2022 Aug;43(8):4847-4851. doi: 10.1007/s10072-022-06079-8. Epub 2022 Apr 21.
Tilt table test represents a valuable diagnostic method in assessing patients with transient loss of consciousness and confirming the diagnosis of vasovagal syncope. However, the test lacks standardization, and various protocols exist in different centers. The aim of this study was to compare the difference in sensitivity and time-to-syncope of tilt table test with a painful stimulus provocation compared to standard test with no provocation.
This was a prospective study that included consecutive patients diagnosed with vasovagal syncope who were referred for tilt table testing. Patients were randomly assigned to two groups: group 1 with pain provocation after the first 10 min of upright position and group 2 with no provocation with further 30 min of tilt in both groups.
In group 1, 66 (78.6%) patients developed syncope while in group 2, 35 (44.3%) patients had syncope (p < 0.001). This represents an increase of 34.3% in TTT sensitivity with the application of painful provocation. According to results of the Cox regression, the hazard for developing syncope after the 10th min of the tilt for group 2 was 0.275 of the hazard of group 1 (95% C.I. 0.170-0.444, p < 0.001).
Pain provocation is a useful method for increasing sensitivity and shortening the duration of tilt table testing.
倾斜试验是评估一过性意识丧失患者和确认血管迷走性晕厥诊断的一种有价值的诊断方法。然而，该测试缺乏标准化，不同中心存在各种方案。本研究的目的是比较疼痛刺激诱发与标准无刺激倾斜试验在敏感性和晕厥时间方面的差异。
这是一项前瞻性研究，纳入了连续诊断为血管迷走性晕厥并转诊进行倾斜试验的患者。患者被随机分配到两组：第 1 组在直立 10 分钟后进行疼痛刺激，第 2 组在两组中进一步倾斜 30 分钟时无刺激。
第 1 组 66 例（78.6%）患者出现晕厥，第 2 组 35 例（44.3%）患者出现晕厥（p<0.001）。这表示疼痛刺激的应用使 TTT 的敏感性增加了 34.3%。根据 Cox 回归的结果，对于第 2 组，倾斜 10 分钟后发生晕厥的危险是第 1 组的 0.275（95%CI 0.170-0.444，p<0.001）。
疼痛刺激是提高倾斜试验敏感性和缩短倾斜试验时间的有用方法。
