Venepuncture during head-up tilt testing in patients with suspected vasovagal syncope - implications for the test protocol.

Humm, Andrea Monika; Z'Graggen, Werner Josef (2015). Venepuncture during head-up tilt testing in patients with suspected vasovagal syncope - implications for the test protocol. European journal of neurology, 22(2), pp. 389-394. Blackwell Science 10.1111/ene.12590

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BACKGROUND AND PURPOSE Head-up tilt (HUT) testing is a widely used diagnostic tool in patients with suspected vasovagal syncope (VVS). However, no gold standard exists for this examination and the various protocols used have a limited sensitivity and specificity. Our aim was to determine the sensitivity of a sequential HUT testing protocol including venepuncture (VP) and sublingual nitroglycerin application. METHODS This was a retrospective analysis of the diagnostic gain of a sequential HUT testing protocol including VP applied 10 min after the start of HUT testing and sublingual application of nitroglycerin 20 min after the start of the test protocol in 106 patients with a final diagnosis of VVS. The sensitivity of the test protocol was compared between patients with positive and negative history for VP induced VVS. RESULTS Overall, pre-syncope or syncope occurred in 68 patients (64.2%). Only 17% of all patients fainted spontaneously within 10 min of passive HUT. Another 39.6% fainted within 20 min. Application of nitroglycerin after 20 min of HUT evoked syncope in another 7.5% until the end of 45 min of HUT. The sensitivity of the test protocol for evoking (pre-)syncope was 94.4% in patients with a positive history for VP associated VVS and 58% in patients with a negative history (P < 0.01**); 85.7% of patients with a positive history and 42.9% of patients with a negative history fainted within 20 min of HUT testing (P < 0.01**). CONCLUSIONS Implementation of VP in sequential HUT testing protocols allows the sensitivity of HUT testing to be increased, especially in patients with a positive history for VP associated VVS.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Humm, Andrea Monika and Z'Graggen, Werner Josef

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1351-5101

Publisher:

Blackwell Science

Language:

English

Submitter:

Valentina Rossetti

Date Deposited:

18 Feb 2015 14:35

Last Modified:

29 Oct 2015 11:57

Publisher DOI:

10.1111/ene.12590

PubMed ID:

25382753

Uncontrolled Keywords:

diagnostic gain, neurally mediated syncope, reflex syncope, sensitivity, taking a blood sample

BORIS DOI:

10.7892/boris.63396

URI:

https://boris.unibe.ch/id/eprint/63396

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