Pollini I, Favilli S, De Simone L, Romanelli A M, Manetti A
UO di Cardiologia, Azienda Ospedaliera A Meyer, Firenze.
Cardiologia. 1998 May;43(5):499-503.
Syncope is a common medical problem with multiple potential causes and it is very frequent in pediatric population . Neurocardiogenic syncope has been increasingly recognized with the introduction of head-up tilt test (HUTT). The study investigates the clinical utility of HUTT in the evaluation and management of children with recurrent syncope and structurally normal heart. Two-hundred-forty-three consecutive young patients with recurrent unexplained syncope, 100 males and 143 females (mean age 11.4 years, range 5 to 20) underwent HUTT using a 60 degree tilt for 45 min. The test was considered positive when it provoked symptoms of syncope with hypotension and/or bradycardia. Twenty-six patients (10.7%) were positive for neurocardiogenic syncope. Of the 26 patients with the positive tilt, 5 (19.2%) had cardioinhibitory response, 5 (19.2%) mixed response and 16(61.6%) vasodepressive response. Nineteen of 143 females (13.3%) and 7 of 100 males (7%) resulted positive (NS). Among patients < 10 years of age 3/41 (9.8%) were positive and among > 10 years 22/202 patients (10.9%) resulted positive (NS). The cardioinhibitory response is more frequent in males (p = 0.01), and the vasodepressive in females (p = 0.05). In our study, concerning a non selected pediatric population a positive test resulted in a lower percentage than previously reported; moreover, the tilt test has appeared a promising method of identifying patients requiring pharmacotherapy. Additional randomized controlled studies are necessary to better define the prognosis and treatment of neurocardiogenic syncope in children and adolescents with positive tilt test. Finally, an assessment of the outcome of young patients with syncope and a negative tilt test is needed.
晕厥是一个常见的医学问题，有多种潜在病因，在儿科人群中非常常见。随着头高位倾斜试验（HUTT）的引入，神经心源性晕厥越来越受到认可。本研究调查了HUTT在评估和管理复发性晕厥且心脏结构正常的儿童中的临床应用价值。243例连续的不明原因复发性晕厥的年轻患者，其中男性100例，女性143例（平均年龄11.4岁，范围5至20岁），采用60度倾斜45分钟进行HUTT。当试验诱发伴有低血压和/或心动过缓的晕厥症状时，该试验被认为是阳性。26例患者（10.7%）神经心源性晕厥试验阳性。在26例倾斜试验阳性的患者中，5例（19.2%）有心脏抑制反应，5例（19.2%）为混合反应，16例（61.6%）为血管抑制反应。143例女性中有19例（13.3%）试验阳性，100例男性中有7例（7%）试验阳性（无统计学差异）。年龄<10岁的患者中3/41（9.8%）试验阳性，年龄>10岁的患者中22/202例（10.9%）试验阳性（无统计学差异）。心脏抑制反应在男性中更常见（p = 0.01），血管抑制反应在女性中更常见（p = 0.05）。在我们的研究中，对于未选择的儿科人群，阳性试验的比例低于先前报道；此外，倾斜试验似乎是识别需要药物治疗患者的一种有前景的方法。需要更多的随机对照研究来更好地确定倾斜试验阳性的儿童和青少年神经心源性晕厥的预后和治疗。最后，需要对晕厥且倾斜试验阴性的年轻患者的结局进行评估。
