title: [Methodology of 80 degrees head-up tilt testing with and without low dose isoproterenol provocation in Japanese patients with neurally mediated syncope].
abstract: The usefulness of 80 degrees head-up tilt testing with and without low dose isoproterenol provocation was evaluated for the diagnosis of neurally mediated syncope (NMS) in Japanese. Head-up tilt testing was performed in 114 consecutive patients with clinical diagnoses of NMS (68 men, 46 women, mean age 46 +/- 21 years), and 57 times in 36 healthy volunteers (26 men, 10 women, mean age 31 +/- 8 years) who had no history of syncope or presyncope. Head-up tilt testing used an 80 degrees angle for 30 minutes (passive tilt), and if the passive tilt resulted in negative response, isoproterenol was infused at 0.01-0.02 microgram/kg/min and the tilt repeated for 10 minutes (isoproterenol tilt). A positive response was defined as the development of syncope or a presyncopal state associated with hypotension, bradycardia or cardiac arrest. The sensitivities of passive tilt testing for a positive response after 5-, 10-, 15-, 20-, 25- and 30-minute tilting were 1%, 9%, 14%, 19%, 24%, and 28%, respectively, and specificities after 5-, 10-, 15-, 20-, 25- and 30-minute tilting were 100%, 95%, 91%, 88%, 86%, and 84%, respectively. The sensitivities of isoproterenol tilt testing with 0.01 and 0.02 microgram/kg/min were increased to 37% and 48%, respectively. This improvement was statistically significant between the passive tilt and isoproterenol tilt testing with a dose of 0.02 microgram/kg/min (p < 0.01). However, specificities were comparable with those of the passive tilt testing (84% and 82%, respectively). In conclusion, 80 degrees passive tilt testing for 30 minutes showed a low sensitivity (28%) but acceptable specificity (84%). Low-dose isoproterenol provocation was useful for improving sensitivity (48%) while maintaining a comparable specificity (82%).
authors.affiliation: Department of Cardiology, Juntendo University Izunagaoka Hospital, Shizuoka.
authors.forename: Y
authors.initials: Y
authors.lastname: Mineda
authors.forename: M
authors.initials: M
authors.lastname: Sumiyoshi
authors.forename: Y
authors.initials: Y
authors.lastname: Nakazato
authors.forename: Y
authors.initials: Y
authors.lastname: Nakata
authors.forename: H
authors.initials: H
authors.lastname: Yamaguchi
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People; D005260:Female; D006801:Humans; D007545:Isoproterenol / Q000008:administration & dosage; D007564:Japan; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D013566:Sympathomimetics / Q000008:administration & dosage; D019462:Syncope, Vasovagal / Q000175:diagnosis*; D018667:Tilt-Table Test / Q000379:methods*
chemical_list: D013566:Sympathomimetics; D007545:Isoproterenol