BACKGROUND: Clinicians may be tempted to consider a positive head-up tilt test (HUTT) an unfavorable prognostic indicator. We investigated whether results of routine HUTT predict long-term recurrence of syncope. METHODS: We analyzed syncope recurrence at long-term among 107 patients (mean age 51 +/- 20 years) receiving HUTT for diagnostic evaluation of unexplained/suspected neurocardiogenic syncope in our Institute. RESULTS: HUTT was positive in 76 patients (vasodepressive response, n = 58; cardioinhibitory, n = 5; mixed, n = 13). During a median follow-up of 113 months (range, 7-161), 34 (32%) patients experienced recurrence (24 [32%] with positive HUTT during 110 months (7-159); 10 [32%] with negative HUTT during 120 [22-161] months). Actuarial freedom from recurrence at 10 years did not significantly differ for patients with positive/negative test results (after passive/active phases) or with different positive response patterns (vasodepressive, cardioinhibitory, mixed). By contrast, history of >4 syncopes in the 12 months preceding HUTT stratified risk of recurrence, irrespective of HUTT positivity/negativity. At Cox proportional hazards analysis, history of >4 syncopes in the 12 months preceding HUTT was the single independent risk factor for recurrence both in the overall study population (HR, 1.7; 95% CI, 1.07-2.69) and within the subset of patients who tested positive (HR, 1.83; 95% CI, 1.07-3.17). CONCLUSIONS: This long-term follow-up study reinforces the concept that a positive HUTT should not be considered an unfavorable prognostic indicator; frequency of recent occurrences may be a more valid predictor.
BACKGROUND: Clinicians may be tempted to consider a positive head-up tilt test (HUTT) an unfavorable prognostic indicator. We investigated whether results of routine HUTT predict long-term recurrence of syncope. METHODS: We analyzed syncope recurrence at long-term among 107 patients (mean age 51 +/- 20 years) receiving HUTT for diagnostic evaluation of unexplained/suspected neurocardiogenic syncope in our Institute. RESULTS: HUTT was positive in 76 patients (vasodepressive response, n = 58; cardioinhibitory, n = 5; mixed, n = 13). During a median follow-up of 113 months (range, 7-161), 34 (32%) patients experienced recurrence (24 [32%] with positive HUTT during 110 months (7-159); 10 [32%] with negative HUTT during 120 [22-161] months). Actuarial freedom from recurrence at 10 years did not significantly differ for patients with positive/negative test results (after passive/active phases) or with different positive response patterns (vasodepressive, cardioinhibitory, mixed). By contrast, history of >4 syncopes in the 12 months preceding HUTT stratified risk of recurrence, irrespective of HUTT positivity/negativity. At Cox proportional hazards analysis, history of >4 syncopes in the 12 months preceding HUTT was the single independent risk factor for recurrence both in the overall study population (HR, 1.7; 95% CI, 1.07-2.69) and within the subset of patients who tested positive (HR, 1.83; 95% CI, 1.07-3.17). CONCLUSIONS: This long-term follow-up study reinforces the concept that a positive HUTT should not be considered an unfavorable prognostic indicator; frequency of recent occurrences may be a more valid predictor.
Authors: Michele Brignole; Paolo Alboni; David G Benditt; Lennart Bergfeldt; Jean-Jacques Blanc; Poul Erik Bloch Thomsen; J Gert van Dijk; Adam Fitzpatrick; Stefan Hohnloser; Jan Janousek; Wishwa Kapoor; Rose Anne Kenny; Piotr Kulakowski; Giulio Masotti; Angel Moya; Antonio Raviele; Richard Sutton; George Theodorakis; Andrea Ungar; Wouter Wieling; Silvia G Priori; Maria Angeles Alonso Garcia; Andrzej Budaj; Martin Cowie; Jaap Deckers; Enrique Fernandez Burgos; John Lekakis; Bertil Lindhal; Gianfranco Mazzotta; João Morais; Ali Oto; Otto Smiseth; Carlo Menozzi; Hugo Ector; Panos Vardas Journal: Eur Heart J Date: 2004-11 Impact factor: 29.983
Authors: A H Madrid; J Ortega; J G Rebollo; J G Manzano; J G Segovia; A Sánchez; G Peña; C Moro Journal: J Am Coll Cardiol Date: 2001-02 Impact factor: 24.094
Authors: F P Sarasin; M Louis-Simonet; D Carballo; S Slama; A Rajeswaran; J T Metzger; C Lovis; P F Unger; A F Junod Journal: Am J Med Date: 2001-08-15 Impact factor: 4.965
Authors: J Freitas; J Puig; J Campos; J M Garcia; D L Cunha; M J Carvalho; O Costa; M C Gomes; A F Freitas Journal: Rev Port Cardiol Date: 1993-09 Impact factor: 1.374