de Ruiter Susanne C, van Marum Rob J, Ruiter Jaap H, Hemels Martin E W, de Groot Joris R, Jansen René W M M
Geriatric Medicine, North West Hospital Group, Alkmaar, Netherlands.
General Medicine and Geriatric Medicine, Amsterdam University Medical Center De Boelelaan Site, Amsterdam, Netherlands.
Age Ageing. 2025 Mar 28;54(4). doi: 10.1093/ageing/afaf086.
In older syncope patients, medical histories are often less reliable due to retrograde amnesia and cognitive impairment. Therefore, additional tests may be needed to reach a diagnosis. We conducted a systematic review to evaluate positivity rates and safety of head-up tilt testing (HUTT) in these patients.
We searched Medline and Embase for HUTT positivity rates and diagnoses in older syncope patients (mean age ≥ 65 years) vs. younger patients. Secondary outcomes were time to syncope (TtS) and adverse events (AEs). Risk of bias was assessed with a modified version of the QUADAS-2.
In total, 42 studies were included, with 12 378 older participants in total. Positivity rates varied widely [passive HUTT 0.0%-90.0%; isoproterenol (IPR)-HUTT 18.3%-64.0%; nitroglycerin-HUTT 30.1%-90.5%]. The majority of studies found no differences between older and younger patients. Specificity was high for all HUTT-protocols (85.5%-100%). TtS did not differ between older and younger patients, but was significantly longer in control subjects. Nitroglycerin-HUTT yielded the most diagnoses (median 64.2% vs. 23.7% for passive, P = .007, and 44.8% for IPR-HUTT, n.s.). Vasodepressive responses were more common than cardioinhibitory responses (median 54.9% vs. 9.1%) in older patients. AEs occurred in <6% of patients with passive/nitroglycerin-HUTT.
DISCUSSION/CONCLUSION: There is no consistent evidence that HUTT results differ between older and younger syncope patients. Nitroglycerin-HUTT yields the most diagnoses, whilst retaining a high specificity, and is safe to perform in older patients. Future studies should focus on the additional value of HUTT on top of the initial evaluation in these patients.
在老年晕厥患者中，由于逆行性遗忘和认知障碍，病史往往不太可靠。因此，可能需要进行额外的检查以做出诊断。我们进行了一项系统评价，以评估这些患者中直立倾斜试验（HUTT）的阳性率和安全性。
我们在Medline和Embase中搜索了老年晕厥患者（平均年龄≥65岁）与年轻患者的HUTT阳性率和诊断情况。次要结局是晕厥发生时间（TtS）和不良事件（AE）。采用修改后的QUADAS-2评估偏倚风险。
共纳入42项研究，老年参与者共计12378名。阳性率差异很大[被动HUTT为0.0%-90.0%；异丙肾上腺素（IPR）-HUTT为18.3%-64.0%；硝酸甘油-HUTT为30.1%-90.5%]。大多数研究发现老年患者和年轻患者之间没有差异。所有HUTT方案的特异性都很高（85.5%-100%）。老年患者和年轻患者的TtS没有差异，但对照组的TtS明显更长。硝酸甘油-HUTT诊断出的病例最多（中位数为64.2%，被动HUTT为23.7%，P = 0.007，IPR-HUTT为44.8%，无统计学差异）。在老年患者中，血管抑制性反应比心脏抑制性反应更常见（中位数分别为54.9%和9.1%）。被动/硝酸甘油-HUTT患者中不良事件的发生率<6%。
讨论/结论：没有一致的证据表明老年和年轻晕厥患者的HUTT结果存在差异。硝酸甘油-HUTT诊断出的病例最多，同时保持高特异性，并且对老年患者进行该检查是安全的。未来的研究应关注HUTT在这些患者初始评估之外的附加价值。
