Utility of a single-stage isoproterenol tilt table test in adults : A randomized comparison with passive head-up tilt

• Published in: Journal of the American College of Cardiology 1999-03, Vol.33 (4), p.985-990
• Main Authors: SHEN, W.-K, JAHANGIR, A, BEINBORN, D, LOHSE, C. M, HODGE, D. O, REA, R. F, HAMMILL, S. C
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; Cross-Over Studies; Diagnosis, Differential; Female; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Isoproterenol; Male; Medical sciences; Middle Aged; Nervous system (semeiology, syndromes); Neurology; Sensitivity and Specificity; Space life sciences; Sympathomimetics; Syncope, Vasovagal - diagnosis; Tilt-Table Test
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/S0735-1097(98)00658-5

This study was conducted to develop a time-efficient tilt table test. Current protocols of tilt table testing are quite time-consuming. This study was designed to assess the diagnostic value, tolerance and procedural time of a single-stage isoproterenol tilt table protocol. A single-stage isoproterenol tilt table test was compared with the passive tilt table test. The study was prospectively designed in a randomized and crossover fashion. The study population consisted of 111 patients with a history of syncope (mean age 55 +/- 20 years). Of the total, 62 patients (56%; 95% confidence interval, 46% to 65%) had a positive vasovagal response during isoproterenol tilt table testing and 35 (32%; 23% to 41%) during passive tilt table testing (p = 0.002). The mean procedural times of the study population were 11.7 +/- 3.6 min and 36.9 +/- 13.3 min for isoproterenol and passive tilt table testing, respectively (p < 0.001). All patients tolerated single-stage isoproterenol testing. In the 23 control subjects (mean age 34 +/- 11 years), the apparent specificities were 91% (72% to 99%) and 83% (61% to 99%) for passive and single-stage tilt table testing, respectively. The single-stage isoproterenol tilt table test was more effective in inducing a positive vasovagal response in an adult population than the standard passive tilt table test, and it significantly reduced the procedural time. The increase in positive yield was associated with a moderate decrease in apparent specificity. These observations support the conclusion that single-stage tilt table testing could be a reasonable diagnostic option in patients undergoing syncope evaluation.