Del Rosso A, Bartoli P, Bartoletti A, Brandinelli-Geri A, Bonechi F, Maioli M, Mazza F, Michelucci A, Russo L, Salvetti E, Sansoni M, Zipoli A, Fierro A, Ieri A
Division of Cardiology, Ospedale S. Pietro Igneo, Fucecchio, University of Florence, Italy.
Am Heart J. 1998 Apr;135(4):564-70. doi: 10.1016/s0002-8703(98)70268-6.
Head-up tilt testing is extensively used to determine the vasovagal origin of syncope in patients with otherwise unexplained loss of consciousness, although issues remain regarding the method of the test. The diagnostic value of a shortened head-up tilt test potentiated with sublingual nitroglycerin was assessed in patients with unexplained syncope.
Two hundred two patients (mean age 49+/-19 years) with syncope of unknown origin and 34 subjects in a control group (mean age 45+/-17 years) were studied. The patients and the subjects in the control group were tilted upright to 60 degrees for 20 minutes. If syncope did not occur, sublingual nitroglycerin (400 microg) was administered, and observation was continued for 25 more minutes.
During the unmedicated phase syncope occurred in 22 (11%) patients and in one member of the control group. After nitroglycerin was administered, syncope occurred in 119 (59%) patients and in 1 (3%) member of the control group. False-positive response (exaggerated response) was observed in eight (4%) patients and in four (12%) subjects in the control group. The total positivity rate of the test was 70% with a specificity rate of 94%.
Short-duration head-up tilt test potentiated with sublingual nitroglycerin provides an adequate specificity and positivity rate in patients with unexplained syncope.
头高位倾斜试验被广泛用于确定不明原因意识丧失患者晕厥的血管迷走神经起源，尽管该试验方法仍存在一些问题。本研究评估了缩短的头高位倾斜试验联合舌下含服硝酸甘油对不明原因晕厥患者的诊断价值。
研究对象包括202例不明原因晕厥患者（平均年龄49±19岁）和34例对照组受试者（平均年龄45±17岁）。将患者和对照组受试者直立倾斜至60度，持续20分钟。如果未发生晕厥，则给予舌下含服硝酸甘油（400微克），并继续观察25分钟。
在未用药阶段，22例（11%）患者和1例对照组受试者发生晕厥。给予硝酸甘油后，119例（59%）患者和1例（3%）对照组受试者发生晕厥。在8例（4%）患者和4例（12%）对照组受试者中观察到假阳性反应（过度反应）。该试验的总阳性率为70%，特异性率为94%。
缩短的头高位倾斜试验联合舌下含服硝酸甘油对不明原因晕厥患者具有足够的特异性和阳性率。
